scholarly journals Bacterial Sensitivity To Chlorhexidine and Povidone-Iodine Antiseptics Over Time: A Systematic Review and Meta-Analysis of Human-Derived Data

Author(s):  
Raiyyan Aftab ◽  
Vikash H Dodhia ◽  
Christopher Jeanes ◽  
Ryckie G Wade

Abstract Background Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is increasing concern of developing resistance to topical biocides, though clinical implications remain unclear. Outcomes: Determining whether the Minimum Bactericidal Concentration (MBC) for topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. Methods We included studies reporting the mean bactericidal concentration (MBC) of laboratory and clinical isolates of common microbes to CHX and PVI. Excluding non-human samples and studies using antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses. Change in MBC over time was explored using meta-regression. Results 79 studies were including, analysing 6218 microbes over 45 years. Most used CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in MBC of CHX to Staphylococci (β 0.12 [-1.13, 1.37]; I2 99%) or Streptococci (β 0.13 [-0.35, 0.62]; I2 97%). Conclusions There is no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. Providing reassurance that the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.

2021 ◽  
Author(s):  
Raiyyan Aftab ◽  
Vikash H Dodhia ◽  
Christopher Jeanes ◽  
Ryckie George Wade

Background: Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Topical biocides such as chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis to minimise SSIs. There is an increasing concern of developing resistance to topical biocides, however the clinical implications of this remains unclear. Outcomes: The objective of this review was to determine whether the Minimum Bactericidal Concentration (MBC) for topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. Methods: We searched for studies which reported the mean bactericidal concentration (MBC) of laboratory and clinical isolates of common SSI causing microbes to CHX and PVI. We excluded samples derived from non-humans and studies using antimicrobial solvents or mixtures of biocides with other active substances. MBC was pooled in random effects meta-analyses and change in MBC over time was explored using meta-regression. Results: 79 studies were including, analysing 6218 microbes between 1976 and 2021. Most studies used CHX (93%) and there was insufficient data for meta-analysis of PVI. Enterobacteriales had the highest MBC for CHX (20 mg/L [95% CI 14, 25]; I 2 95%) whilst MRSA had the lowest (3 mg/L [95% CI 1, 2]; I 2 93%). There was no change in MBC of CHX to Staphylococci (β 0.12 [-1.13, 1.37]; I 2 99%) or Streptococci (β 0.13 [-0.35, 0.62]; I 2 97%). Conclusions: There is no evidence of change in susceptibility of common SSI-causing microbes to CHX over time. This study provides reassurance that the worldwide guidance that CHX should remain the first-choice agent for skin asepsis prior to surgery.


Ból ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 25-38
Author(s):  
Anker Stubberud ◽  
Nikolai Melseth Flaaen ◽  
Douglas C. McCrory ◽  
Sindre Andre Pedersen ◽  
Mattias Linde

Based on few clinical trials, flunarizine is considered a first-line prophylactic treatment for migraine in several guidelines. In this meta-analysis, we examined the pooled evidence for its effectiveness, tolerability, and safety. Prospective randomized controlled trials of flunarizine as a prophylaxis against migraine were identified from a systematic literature search, and risk of bias was assessed for all included studies. Reduction in mean attack frequency was estimated by calculating the mean difference (MD), and a series of secondary outcomes –including adverse events (AEs) – were also analyzed. The database search yielded 879 unique records. Twentyfive studies were included in data synthesis. We scored 31/175 risk of bias items as “high”, with attrition as the most frequent bias. A pooled analysis estimated that flunarizine reduces the headache frequency by 0.4 attacks per 4 weeks compared with placebo (5 trials, 249 participants: MD 20.44; 95% confidence interval 20.61 to 2 0.26). Analysis also revealed that the effectiveness of flunarizine prophylaxis is comparable with that of propranolol (7 trials, 1151 participants, MD 20.08; 95% confidence interval 20.34 to 0.18). Flunarizine also seems to be effective in children. The most frequent AEs were sedation and weight increase. Meta-analyses were robust and homogenous, although several of the included trials potentially suffered from high risk of bias. Unfortunately, reporting of AEs was inconsistent and limited. In conclusion, pooled analysis of data from partially outdated trials shows that 10- mg flunarizine per day is effective and well tolerated in treating episodic migraine – supporting current guideline recommendations.


2016 ◽  
Vol 40 (3) ◽  
pp. 425-446 ◽  
Author(s):  
Barbara L. Cannella ◽  
Adela Yarcheski ◽  
Noreen E. Mahon

The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor–health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal–fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.


Author(s):  
Naia Bustamante-Hernández ◽  
Jose María Montiel-Company ◽  
Carlos Bellot-Arcís ◽  
José Félix Mañes-Ferrer ◽  
María Fernanda Solá-Ruíz ◽  
...  

A systematic review and meta-analysis was performed to analyze the survival of onlay restorations in the posterior region, their clinical behavior according to the material used (ceramic reinforced with lithium disilicate, conventional feldspathic ceramic or reinforced with leucite; hybrid materials and composite), possible complications, and the factors influencing restoration success. The systematic review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, without publication date or language restrictions. An electronic search was made in the PubMed, Scopus, Embase, and Cochrane databases. After discarding duplicate publications and studies that failed to meet the inclusion criteria, the articles were selected based on the population, intervention, comparison, outcome (PICO) question. The following variables were considered in the qualitative and quantitative analyses: restoration survival rate (determined by several clinical parameters), the influence of the material used upon the clinical behavior of the restorations, and the complications recorded over follow-up. A total of 29 articles were selected for the qualitative analysis and 27 for the quantitative analysis. The estimated restoration survival rate was 94.2%. The predictors of survival were the duration of follow-up (beta = −0.001; p = 0.001) and the onlay material used (beta = −0.064; p = 0.028). Composite onlays were associated with a lower survival rate over time. Onlays are a good, conservative, and predictable option for restoring dental defects in the posterior region, with a survival rate of over 90%. The survival rate decreases over time and with the use of composite as onlay material.


2019 ◽  
Vol 6 (10) ◽  
pp. 190937 ◽  
Author(s):  
Melissa Bateson ◽  
Dan T. A. Eisenberg ◽  
Daniel Nettle

Longitudinal studies have sought to establish whether environmental exposures such as smoking accelerate the attrition of individuals' telomeres over time. These studies typically control for baseline telomere length (TL) by including it as a covariate in statistical models. However, baseline TL also differs between smokers and non-smokers, and telomere attrition is spuriously linked to baseline TL via measurement error and regression to the mean. Using simulated datasets, we show that controlling for baseline TL overestimates the true effect of smoking on telomere attrition. This bias increases with increasing telomere measurement error and increasing difference in baseline TL between smokers and non-smokers. Using a meta-analysis of longitudinal datasets, we show that as predicted, the estimated difference in telomere attrition between smokers and non-smokers is greater when statistical models control for baseline TL than when they do not, and the size of the discrepancy is positively correlated with measurement error. The bias we describe is not specific to smoking and also applies to other exposures. We conclude that to avoid invalid inference, models of telomere attrition should not control for baseline TL by including it as a covariate. Many claims of accelerated telomere attrition in individuals exposed to adversity need to be re-assessed.


2015 ◽  
Vol 139 (10) ◽  
pp. 1302-1307 ◽  
Author(s):  
Michael Kinzler ◽  
Lanjing Zhang

Context No studies to our knowledge have investigated citations and utilization of meta-analysis in diagnostic pathology (DP). Objective To characterize meta-analyses in DP compared with meta-analyses in medicine. Design We searched PubMed for meta-analyses in 12 major DP journals without specifying years and in 4 major medicine journals in both 2006 and 2011. We compared articles' adjusted citation ratios (ACRs), defined as an article's citation count divided by the mean citations for the meta-analysis, review, and original research articles published in the same journal in the same year. Results Forty-one of 76 DP articles, 74 of 125 medicine articles in 2011, and 52 of 83 medicine articles in 2006 were qualified meta-analyses as identified by PubMed. The ACRs of DP meta-analysis articles were higher than those of original research articles (2.62 ± 2.31 versus 0.92 ± 0.84, P < .001) and similar to those of review articles in 2006 (2.62 ± 2.31 versus 1.95 ± 1.59, P = .50), but they were similar to both in 2011 (1.85 ± 1.39 versus 0.99 ± 1.43, P = .11; 1.85 ± 1.39 versus 1.12 ± 1.43, P = .21, respectively). Diagnostic pathology and medicine meta-analyses had similar ACRs (1.85 ± 1.39 versus 1.57 ± 1.35 in 2011, P = .60; and 2.62 ± 2.31 versus 1.85 ± 1.90 in 2006, P = .50, respectively). However, although DP journals published fewer meta-analyses (0.97% versus 6.66% in 2011 and 0.67% versus 4.40% in 2006, P < .001 for both), they published more meta-analyses using both original and published data than medicine (21.95% versus 1.59%, P < .001). They also published more meta-analyses per year in 2011–2014 than in 2000–2010 (6.4 ± 1.29 versus 1.36 ± 1.03 articles per year, P < .001). Conclusions We found underutilization of meta-analyses in DP, despite their high ACRs and recently increased utilization. More DP meta-analyses are needed.


Author(s):  
Israel Baptista de Souza Borges ◽  
Magali Rezende de Carvalho ◽  
Marcel de Souza Quintana ◽  
Alexandre Barbosa de Oliveira

Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I2= 74%). The “2ndgeneration supraglottic devices” subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).


2019 ◽  
Vol 27 (2) ◽  
pp. 150-159
Author(s):  
Francesco Mongelli ◽  
Davide La Regina ◽  
Irin Zschokke ◽  
Marcello Ceppi ◽  
Antonjacopo Ferrario di Tor Vajana ◽  
...  

Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.


2020 ◽  
Vol 25 (2) ◽  
pp. 163-181 ◽  
Author(s):  
Laura Marciano ◽  
Peter J Schulz ◽  
Anne-Linda Camerini

Abstract Cyberbullying perpetration (CP) and victimization (CV) are prevalent issues in adolescent development. However, previous meta-analyses focused only on cross-sectional findings. The present study aims to meta-analytically summarize 56 longitudinal studies on CP, CV, and related factors in children and adolescents. Forty meta-analyses on CP and CV as both predictors and outcomes of person-related, Internet activity-related, and contextual factors were performed. Additional moderator analyses took into account study design, sample population, and quality of the studies. Results highlight reciprocal longitudinal effects among CP, CV, and both traditional bullying and victimization: CP causes externalizing problem behaviors over time, whereas CV constitutes a risk factor of internalizing problems, such as depression and anxiety. Conversely, behavioral problems and increased Internet use predict involvement in CP, while depression, anxiety, and Internet use also predict CV over time. Further longitudinal research is needed to provide empirical evidence on understudied concepts.


Author(s):  
Kerrie Mengersen ◽  
Michael D. Jennions ◽  
Christopher H. Schmid

In many meta-analyses, independence is questionable because there are several effect estimates per study and/or some of the individual studies included in the meta-analysis might not provide independent estimates of the effect. Within-study nonindependence can arise due to multiple measures of the same effect on the same experimental units being made over time, multiple treatments being compared to the same set of control individuals, or different measures being taken (e.g., plant height, dry weight, and photosynthesis rate) from the same experimental units to generate several different effect size estimates. This chapter discusses nonindependence among effect sizes both within and among studies. It focuses on four commonplace situations where nonindependence can occur in ecology and evolution meta-analyses. Each of these four situations is illustrated with a single case study.


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