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PubMed2003

Synergistic inhibition of the growth in vitro of Microsporum canis by miconazole and chlorhexidine.

An agar dilution technique was used to assess the minimum inhibitory concentrations (MIC) of miconazole, chlorhexidine and a 1:1 combination of both agents for 10 isolates of Microsporum canis. For nine of 10 of the isolates, a combination of miconazole and chlorhexidine was more effective than either agent alone; fractional inhibitory concentration indices indicated a synergistic effect for five isolates and an additive effect for four. These results illustrate the potent antimycotic effect of miconazole and chlorhexidine against M. canis and are in accordance with previous clinical studies that showed the value of using miconazole and chlorhexidine shampoo in association with oral griseofulvin in the treatment of feline dermatophytosis caused by M. canis.

Animals↗
PubMed2002

An effective method of inactivating chlorhexidine.

OBJECTIVE: The purpose of this study was to find an effective inactivating agent for chlorhexidine that would facilitate removal of all residual antimicrobial effect, which may cause false-negative results during microbiologic culturing. STUDY DESIGN: L-alpha-lecithin, Tween 80, and sodium thiosulfate were used in different proportions to prepare 6 potential inactivating solutions. Nine mL of each inactivating solution was mixed with 1 mL of 2% chlorhexidine solution. After 5 minutes of equilibration, 0.1 mL of bacterial cell suspension containing 2 x 10(4) viable cell of Enterococcus faecalis was added to the mixture. At 10 and 60 minutes, 0.1-mL aliquots were withdrawn and spread over blood agar plates and incubated at 37 degrees C for 72 hours. The number of colony-forming units on the blood agar plates was determined and recorded. RESULTS: The combination of 3% Tween 80 and 0.3% L-alpha-lecithin was found to be the most effective inactivating agent, allowing full recovery of the test organisms in the presence of chlorhexidine. CONCLUSION: The present study demonstrated a method to predictably inactivate chlorhexidine.

Anti-Infective Agents, Local↗
PubMed1998

Effect of NaF-, SnF2-, and chlorhexidine-impregnated birch toothpicks on mutans streptococci and pH in approximal dental plaque.

The antimicrobial effect of birch toothpicks impregnated with 4% NaF, 8% SnF2, or 2% chlorhexidine was studied both in vitro and in vivo. A non-impregnated toothpick served as a control. In vitro, suspensions of Streptococcus mutans were exposed to the various toothpicks for 20 min and then cultured on blood agar. The results of this susceptibility test revealed the following ranking order with respect to inhibition: chlorhexidine > SnF2 > NaF and non-impregnated; with significant differences in colony-forming units (CFU) between these three groups. In vivo, 12 individuals used the 4 types of toothpick 3 times a day for 5 days in a procedure with a crossover design. Saliva and approximal plaque samples were collected at baseline and on various occasions up to 23 days after the treatment. At the same time, plaque-pH was measured at approximal sites 10 min after rinsing with 10% sucrose. The results of these in vivo experiments revealed lower proportions of mutans streptococci after using all four types of toothpick, but the reduction was significant only after 2 days for the toothpicks impregnated with SnF2 and chlorhexidine (P< 0.05). On the sampling occasions 9 and 23 days after the treatment, the mutans streptococci were more or less back to baseline levels again. In saliva no significant differences in the number of mutans streptococci were found either within or between the four treatments. No significant differences were found regarding decline in the plaque-pH between the NaF-, SnF2-, chlorhexidine-, and non-impregnated toothpicks on any of the sampling occasions.

Adult↗
PubMed2003

Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine.

The use of chlorhexidine gluconate solution for vascular catheter insertion site care reduces the risk of catheter-related bloodstream infection by one-half, compared with povidone iodine. Our objective was to evaluate the cost-effectiveness of chlorhexidine gluconate versus povidone iodine. We used data from randomized, controlled trials, meta-analyses, and epidemiologic studies to construct a decision analysis model. We estimated that use of chlorhexidine, rather than povidone, for central catheter site care resulted in a 1.6% decrease in the incidence of catheter-related bloodstream infection, a 0.23% decrease in the incidence of death, and savings of 113 dollars per catheter used. For peripheral catheter site care, the results were similar, although the differences were smaller. The results were found to be robust on multivariate sensitivity analyses. Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter site care is a simple and cost-effective method of improving patient safety in the hospital setting.

Anti-Infective Agents, Local↗
PubMed2002

Skin antisepsis kits containing alcohol and chlorhexidine gluconate or tincture of iodine are associated with low rates of blood culture contamination.

OBJECTIVE: Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine. DESIGN: Prospective, blinded clinical trial. SETTING: Tertiary-care teaching hospital. PATIENTS: Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures. INTERVENTIONS: House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other. RESULTS: Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215, 1.4%; P = .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination. CONCLUSIONS: Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.

2-Propanol↗
PubMed2004

In vitro assessment of chlorhexidine gluconate-impregnated polyurethane foam antimicrobial dressing using zone of inhibition assays.

OBJECTIVE: To evaluate an antimicrobial dressing consisting of hydrophilic polyurethane foam with chlorhexidine gluconate for activity against several antibiotic-resistant clinical isolates as well as American Type Culture Collection reference strains using zone of inhibition assays. METHODS: Sterile foam samples with chlorhexidine gluconate and untreated controls were transferred onto inoculated agar plates. Plates were incubated at 35 degrees C to 37 degrees C for 24 hours and examined for zones of inhibition around the foam samples. RESULTS: Polyurethane foam with chlorhexidine gluconate showed antimicrobial activity in vitro against all of the challenge organisms including antibiotic-resistant clinical isolates. CONCLUSION: The data from this in vitro study support the hypothesis that polyurethane foam with chlorhexidine gluconate has an antimicrobial effect against antibiotic-resistant Staphylococcus and Enterococcus species, as well as Candida species.

Anti-Infective Agents, Local↗
PubMed1997

The risk of peripheral vein phlebitis associated with chlorhexidine-coated catheters: a randomized, double-blind trial.

OBJECTIVE: To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins. DESIGN: A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters. SETTING: A university hospital. PATIENTS: Adult medicine and surgery patients. INTERVENTIONS: Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture. RESULTS: Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P = .32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P = .06), but not when all catheters were considered in both patient groups (P = .31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P = .85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P = .07). CONCLUSION: The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidine-coated polyurethane catheters compared to otherwise identical uncoated catheters.

Adult↗
PubMed1998

An outbreak of Serratia marcescens infections related to contaminated chlorhexidine.

An outbreak of Serratia marcescens infections occurred in a university tertiary-care hospital. Alcohol-free chlorhexidine solutions were contaminated with S marcescens. The majority of patient and chlorhexidine strains had similar pulsed field-gel electrophoresis banding patterns. Chlorhexidine was recalled, and the rate of S marcescens isolation returned to baseline. Chlorhexidine without alcohol should not be used as an antiseptic.

Anti-Infective Agents, Local↗
PubMed1990

The effect of chlorhexidine acetate on the corneal penetration of sorbitol from an arnolol formulation in the albino rabbit.

The effect of chlorhexidine acetate on the corneal penetration of sorbitol was evaluated in vitro using the enucleated pigmented rabbit cornea mounted in a modified Ussing chamber. Sorbitol penetrated the cornea poorly when compared with arnolol, a beta blocker. Sorbitol penetration was improved 85% by 0.01% chlorhexidine acetate, 2.9 times by 0.1% EDTA, and 9.6 times by stripping the corneal epithelium prior to the start of the experiment. By comparison, 0.01% chlorhexidine acetate and stripping the corneal epithelium improved the corneal penetration of arnolol only 30% and 74%, respectively, whereas stripping the corneal epithelium did not affect the corneal penetration of chlorhexidine acetate. Collectively, the above findings indicate that changes in corneal integrity may dramatically affect the corneal penetration of some inert excipients in ophthalmic formulations. Such a possibility must be considered carefully in the selection of excipients.

Amino Alcohols↗
PubMed2003

Antibacterial efficacy of a new chlorhexidine slow release device to disinfect dentinal tubules.

Dentinal tubules of 27 cylindrical bovine root specimens were infected with Enterococcus faecalis. In nine specimens, 5% chlorhexidine was placed in a slow-release device (Activ Point) for 7 days, in another nine irrigation with 10 ml of 0.2% chlorhexidine was used, and the remaining nine served as positive control. Powder dentin samples obtained from within the canal lumina using ISO 025 to 033 burs were examined for the presence of vital bacteria by inoculating brain-heart infusion plates and counting colony forming units. Results were analyzed using analysis of variance and covariance with repeated measures. Heavy bacterial infection was observed at the layer close to the lumen in the control specimens, decreasing rapidly from layer to layer up to the deepest layer tested (400-500 microm), which contained several hundred colony forming units. Viable bacteria in each layer of dentin were significantly reduced with chlorhexidine irrigation solution (p < 0.01) and were completely eliminated with the chlorhexidine slow-release device (p < 0.01).

Analysis of Variance↗
PubMed2003

The effect of passive ultrasonic activation of 2% chlorhexidine or 5.25% sodium hypochlorite irrigant on residual antimicrobial activity in root canals.

Ninety-four single-canal roots were prepared using the step-down technique. Forty-two canals were irrigated with 2% chlorhexidine, 42 canals with 5.25% sodium hypochlorite (NaOCl), and 10 control canals with phosphate-buffered saline (PBS). The chlorhexidine and NaOCl groups were each then equally divided into a final irrigation group and a 1-min passive ultrasonic irrigation group. Canals were enlarged with a Parapost drill. The apical 3-5 mm was covered with nail polish. Canals were rinsed with PBS, dried, refilled with PBS, and stored. At 6 h, 20 microl of fluid was pipetted from each canal and placed into wells on agar plates, which were inoculated with Streptococcus sanguinis. The plates were incubated, and zones of inhibition were measured. Sampling was repeated at 24, 48, 72, 96, 120, 144, and 168 h. Residual antimicrobial activity with 2% chlorhexidine was statistically significantly superior to 5.25% NaOCl with irrigation alone and with final passive ultrasonic activation (p < 0.001). Chlorhexidine experimental groups demonstrated residual antimicrobial activity for as long as 168 h.

Anti-Infective Agents, Local↗
PubMed2005

Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study.

UNLABELLED: Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl alcohol paint provide superior local flora reduction than povidone-iodine scrub and paint. Patients with intact, uninfected skin having clean elective foot and ankle surgery were prospectively enrolled and randomly assigned to skin preparation with povidone-iodine (Group 1) or chlorhexidine scrub and isopropyl alcohol paint (Group 2). Culture swabs (aerobic, anaerobic, acid fast, fungus, and routine antibiotic sensitivity) were taken from all web spaces, nail folds, toe surfaces, and proposed surgical incision sites. One-hundred twenty-seven patients were enrolled (mean age, 46 years; range, 16-85 years). Sixty-seven patients were assigned to Group 1; 60 patients were assigned to Group 2. In Group 1, 53 of 67 patients (79%) had positive cultures; in Group 2, 23 of 60 patients (38%) had positive cultures. These data indicate that chlorhexidine and alcohol provide better reduction in bacterial carriage than povidone-iodine. Based on these data, we recommended chlorhexidine as the surgical preparatory agent for the foot and ankle. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (significant difference). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1985

Effect of chlorhexidine gluconate on the adherence of Candida species to denture acrylic.

The effect of pretreatment of denture acrylic with chlorhexidine gluconate on the subsequent adherence of Candida albicans GDH 2346 was measured in vitro. Adherence was significantly reduced by pretreatment with chlorhexidine; maximal inhibition was achieved by incubation at room temperature for 30 min in 2% chlorhexidine. Inhibition of adherence was greatest when the organisms were grown in conditions that enhanced adherence the most, i.e., growth to stationary phase in high concentrations of galactose and sucrose. Yeasts grown in high concentrations of galactose, which were the most adherent to acrylic, were also the most sensitive to the fungicidal action of chlorhexidine gluconate, whereas those grown in a low concentration of glucose were the least adherent and also the most resistant. Adherence to acrylic of seven strains of C. albicans isolated from active infections (I strains) and grown in medium containing 500 mM sucrose was significantly higher than that of four strains obtained from asymptomatic carriers (C strains). A spectrum of adherence values was obtained when various yeasts other than C. albicans were tested.

Acrylic Resins↗
PubMed1986

Effect of saliva and serum on the adherence of Candida species to chlorhexidine-treated denture acrylic.

The effect of saliva and serum on the adherence of five strains of Candida albicans and one each of C. tropicalis and C. glabrata to chlorhexidine-pretreated acrylic was measured in vitro. A four-fold dilution of saliva or serum significantly inactivated the fungicidal effect of chlorhexidine gluconate. Pretreatment of the acrylic with unstimulated mixed saliva for 30 min led to a reduced adherence for all the Candida strains tested, whilst a similar pretreatment with serum slightly increased adhesion. Moreover treatment of saliva- or serum-coated acrylic with chlorhexidine gluconate 2% reduced adherence by between 19% and 86%. The inhibition of yeast adherence by chlorhexidine persisted for up to 19 days after the exposure of the acrylic strips to the disinfectant.

Adhesiveness↗
PubMed2006

In vitro antimicrobial activity of sodium hypochlorite and chlorhexidine against selected single-species biofilms.

AIM: To investigate the antimicrobial activity of 2.5% and 5.25% sodium hypochlorite and 2.0% chlorhexidine gel and liquid as endodontic-irrigating substances against selected single-species biofilms. METHODS: Single-species biofilms of Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Prevotella intermedia, Porphyromonas gingivalis, Porphyromonas endodontalis and Fusobacterium nucleatum were generated on a cellulose nitrate membrane placed on agar medium. The biofilms were then immersed in the endodontic-irrigating substances for 30 s and also for 5, 10, 15, 30 and 60 min, with and without mechanical agitation. Sterile saline was used as control. After each time period, the membrane filters were then transferred to tubes containing 2 mL of fresh broth medium plus neutralizers (in order to prevent the residual action of the tested substances). The micro-organisms were suspended using a vortex, and the inoculum was serially diluted 10-fold. Aliquots of the dilutions were plated on 5% sheep blood agar medium, and incubated under adequate gaseous conditions. Colony-forming units were calculated. The samples were compared using the Friedman and Tukey test, when necessary, at a significance level of P < 0.05. RESULTS: Mechanical agitation promoted the effectiveness of the antimicrobial agents, resulting in less time to eliminate the same micro-organisms, except for S. aureus with 2.5% NaOCl. Antimicrobial agents in liquid presentation, especially 5.25% NaOCl and 2% chlorhexidine, killed the tested micro-organisms more rapidly. Saline did not inhibit the growth of any of the tested micro-organisms, with or without agitation, being statistically different (P < 0.05) from NaOCl and chlorhexidine. P. intermedia, P. gingivalis, P. endodontalis and F. nucleatum were eliminated in 30 s by all antimicrobial agents, with our without agitation, in contrast with the facultative and aerobe strains. CONCLUSIONS: Mechanical agitation improved the antimicrobial properties of the chemical substances tested using a biofilm model, favouring the agents in liquid presentation, especially 5.25% NaOCl and 2% chlorhexidine.

Anti-Infective Agents, Local↗
PubMed1986

Resistance of Providencia stuartii to chlorhexidine: a consideration of the role of the inner membrane.

Spheroplasts of three strains of Providencia stuartii (one sensitive, one moderately sensitive and one resistant to chlorhexidine) were induced by cefoxitin, glycine or a lysozyme-tris-EDTA combination, and their susceptibility to chlorhexidine-induced lysis investigated. Maximum lysis of spheroplasts occurred at a low (2.5-5 micrograms/ml) concentration of chlorhexidine and was greatest with the most sensitive strain, Pv2. The possible role of the inner membrane in chlorhexidine resistance is considered in the light of the findings obtained.

Bacteriolysis↗
PubMed1987

The sporicidal activity and inactivation of chlorhexidine gluconate in aqueous and alcoholic solution.

The sporicidal activity of chlorhexidine gluconate in aqueous and alcoholic solution against spores of Bacillus subtilis was examined over a broad temperature range. Activity was not observed at 20 degrees C even with concentrations as high as 10% chlorhexidine. Temperatures of 37 degrees-70 degrees C in combination with such high concentrations were required for reductions in spore viability. No viable spores were recoverable after 4 h contact at 55 degrees C with 10% aqueous chlorhexidine and none after 3 h contact with the alcoholic solution. Because of the high concentrations necessary for activity and the possibility of sporostasis occurring from inefficient chlorhexidine inactivation, existing inactivation systems were examined and modified to obtain satisfactory results. The spores of other Bacillus species examined (B. cereus, B. megaterium and B. stearothermophilus) proved to be considerably less resistant than those of B. subtilis. Presence of organic matter had little effect on the activity.

Bacillus subtilis↗
PubMed1987

Influence of specific growth rate and nutrient limitation upon the sensitivity of Escherichia coli towards chlorhexidine diacetate.

The sensitivity of Escherichia coli to chlorhexidine has been assessed for cells grown in a chemostat at a variety of specific growth rates, under conditions of carbon, nitrogen, phosphorus and magnesium limitation. At slow rates of growth (ca 0.08/h) little difference in sensitivity was observed. As growth rate was increased, however, the sensitivity of nitrogen- and carbon-limited cells increased whilst that of magnesium- and phosphate-limited cells decreased. It was not possible to correlate the observed patterns of chlorhexidine sensitivity with any single measure of cell envelope composition (phospholipid content, lipopolysaccharide, envelope proteins, etc.). The results presented are not consistent, therefore, with any simple model for chlorhexidine binding or action and more probably reflect subtle interaction between chlorhexidine, phospholipid-lipopolysaccharide complexes and cations within the envelope.

Bacterial Outer Membrane Proteins↗