Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% nasal cream

Catheter-associated urinary tract infections (CAUTIs) are a prevalent and preventable healthcare-associated infection that significantly impacts healthcare systems, contributing to increased patient morbidity, length of stay, and costs. This systematic review aims to evaluate the effectiveness of various interventions in reducing CAUTI incidence in healthcare settings. Following the PRISMA guidelines, we conducted a thorough literature search across multiple databases-Web of Science, Scopus, PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar-up to August 8, 2024. Eligible studies included randomized controlled trials, case-control studies, and experimental designs that met inclusion criteria, namely CAUTIs prevention among hospitalized adult patients. After screening 9,476 titles and abstracts, we reviewed 163 texts in full. Of these, 12 studies were included in this review. Results showed that antiseptic solutions like chlorhexidine, specialized catheters (e.g., BIP Foley and silver alloy-coated types) and educational sessions all significantly reduced CAUTI rates, with some interventions achieving reductions as high as 94%. Reminder systems promoting timely catheter removal and amikacin bladder washing also showed notable effectiveness. Adverse effects were minimal. This review underscores the importance of evidence-based CAUTI prevention strategies and the need for consistent implementation across healthcare facilities. Enhanced catheter maintenance practices and judicious catheter use can significantly reduce CAUTI rates, thereby improving patient outcomes and reducing healthcare-associated costs. Future research should continue exploring diverse, context-specific interventions to address barriers to CAUTI prevention.

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Devastating or nearly invariably fatal infections caused by free-living amoebae (FLA), including Acanthamoeba keratitis (AK), granulomatous amoebic encephalitis (GAE), and primary amoebic meningoencephalitis (PAM), remain a significant public health concern, driven by increasing case numbers, geographic expansion, and the lack of approved, effective, and safe treatments. Despite decades of research, no new drugs have been successfully approved, highlighting the severe limitations of de novo drug development for these infections, particularly for GAE and PAM, largely due to the challenges of conducting clinical trials for these rare and rapidly lethal diseases. In this context, drug repurposing represents a cost-effective and promising strategy to accelerate therapeutic advances and overcome key bottlenecks of conventional drug development. Accordingly, we conducted a systematic review of in vitro studies and animal models of AK, GAE, and PAM reported in indexed databases to identify promising drug repurposing candidates against FLA infections. After screening 23,624 records, 112 studies were included in the analysis. Overall, 2726 drugs and drug combinations, spanning 865 pharmacological classes and approved for 565 therapeutic indications, were assessed for their repurposing potential. Among these, 166 compounds showed substantial trophocidal activity (≥IC50) at potentially translatable concentrations (≤10 µM), including six with additional cysticidal activity. In vitro, four compounds were active against Balamuthia mandrillaris, 44 against Acanthamoeba spp. (three cysticidal), and 115 against Naegleria spp. (three cysticidal). In in vivo studies, sulfadiazine and rifampicin were effective as preventive or early monotherapies for GAE. For AK, the combination of polyhexamethylene biguanide, neomycin, and atropine, as well as voriconazole and nitazoxanide monotherapies, showed the greatest promise. In PAM, azithromycin alone or in combination with amphotericin B emerged as the most promising therapeutic options. Further studies are required to advance the clinical translatability of these findings. To the best of our knowledge, this work provides the first comprehensive and integrated synthesis of repurposable drug candidates against FLA infections.

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Background The bacterium Staphylococcus aureus is a leading cause of hospital-acquired infections. These infections are difficult to treat when there is increasing resistance to penicillin, known as methicillin-resistant Staphylococcus aureus . Patients who carry Staphylococcus aureus in the nose and skin are prone to developing infections and many patients admitted to hospital are routinely ‘decolonised’ to reduce this risk. The current standard treatment for nasal decolonisation is the antibiotic nasal mupirocin. There are concerns about over-reliance on a single treatment and the risk of mupirocin-resistant methicillin-resistant Staphylococcus aureus . Robust evidence for alternatives to mupirocin is required. Objective To investigate whether there are clinically and cost-effective alternatives to mupirocin for early nasal decolonisation of methicillin-resistant Staphylococcus aureus among adult hospital inpatients. Design and methods We designed a multicentre, three-arm parallel-group, non-inferiority, randomised controlled trial with economic and qualitative evaluations, to recruit 3000 participants. Setting and participants Adult hospital inpatients identified as being colonised with methicillin-resistant Staphylococcus aureus on routine hospital admission screening were eligible for inclusion. Interventions Participants were randomised (ratio 1 : 1 : 1) to receive one of the following decolonisation treatments: mupirocin (2%) nasal ointment (3 g), polyhexanide (0.1%) nasal gel (30 ml) or chlorhexidine (0.1%) with neomycin (0.5%) nasal cream (15 g). Neither participants nor the investigators were blind to treatment allocation. Main outcome measures The primary outcome was successful early nasal decolonisation, defined as a negative trial specific nasal methicillin-resistant Staphylococcus aureus swab taken 48 hours following treatment completion. Secondary outcomes included successful early nasal decolonisation of methicillin-resistant Staphylococcus aureus not fully susceptible to mupirocin, successful late nasal decolonisation, acceptability of treatment to patients, methicillin-resistant Staphylococcus aureus infections, length of hospital inpatient stays and re-admissions, adverse events and mortality. Outcomes were collected up to 4 weeks following treatment completion. Results Recruitment and retention of participants were much lower than expected. In total, 297 patients were assessed for eligibility and 32 patients randomised. All participants received treatment as allocated. Seven participants withdrew from the study. The mean age was 73.8 years (standard deviation 16.6 years), with 62.5% ( n = 20) of participants being male. Semistructured interviews were undertaken with patients ( N = 5), clinical teams ( N = 19) and clinical trials unit staff ( N = 5) to explore barriers and facilitators to recruitment and consent processes. Data from the qualitative evaluation contributed to progress discussions at trial management meetings and resulting remedial activities undertaken. Limitations The trial closed early after reaching < 2% of the recruitment target. The planned statistical and health economic analyses could not be conducted due to the limited data. The study objectives were not addressed due to poor recruitment. Conclusions It was not feasible to recruit to this trial in the current context, due to a reduced level of methicillin-resistant Staphylococcus aureus testing being undertaken in hospitals within the National Health Service. Future work To facilitate future research, further understanding of the routine decolonisation pathways in line with the revision to national guidance issued in 2021 is required. Validation of methicillin-resistant Staphylococcus aureus viability to increase processing time for nasal swabs could be undertaken and further exploration of the use of self-swabbing at home. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132718.

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Background: Ventilator-associated pneumonia (VAP) is a major cause of infection in patients, and reducing oral cavity contamination can lower mortality rates due to VAP. This study evaluates the effects of the combined administration of three medications, colistin, chlorhexidine, and tobramycin, on the prevention of VAP. Materials and Methods: This double-blind randomized clinical trial was conducted on 96 patients connected to ventilators and admitted to the intensive care unit of Al-Zahra Hospital in Isfahan. The patients were randomly divided into three groups of 32. Over five days, they received “Colistin + Chlorhexidine,” “Tobramycin + Chlorhexidine,” and “Chlorhexidine-alone” four times daily. The Clinical Pulmonary Infection Score (CPIS), patients’ oral hygiene using the Beck Oral Assessment Scale (BOAS), and positive or negative results of oral and tracheal cultures were evaluated before and after the intervention. Results: The results of the present study showed that the CPIS score in the chlorhexidine + colistin group, with the mean of 7.23 ± 1.87, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 12.32 ± 2.67 and 14.05 ± 1.10, respectively ( P = .038). Additionally, the BOAS score in the chlorhexidine + colistin group, with the mean of 3.04 ± 1.02, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 6.25 ± 2.00 and 7.06 ± 2.35, respectively ( P = .042). Conclusion: Preventive and hygienic oral care is an effective factor in reducing VAP. There was no significant difference among the three treatment combinations in reducing the incidence of VAP. However, it appears that adding colistin may have a slightly better performance in preventing lung infections and inhibiting bacterial agents.

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ABSTRACT The aim of this study was to determine the antiamoebic efficacy of povidone-iodine when used as an adjunct to topical biguanide therapy for Acanthamoeba keratitis. Patients with smear- or culture-positive Acanthamoeba keratitis received topical chlorhexidine 0.04%, half-hourly for 2 days, then hourly for days 3–6, then eight times per day for days 7–28. Participants were randomized in a 1:1 ratio to receive either adjunctive topical povidone-iodine at the same frequency as chlorhexidine or no additional therapy (i.e., control group). Povidone-iodine was initially administered as a 2.5% solution but was reduced to a 1% solution after several reports of intolerance. The primary outcome was Acanthamoeba growth from the culture of corneal scrapings at 1, 2, and 4 weeks after randomization, as assessed by laboratory staff masked to treatment allocation. Of 49 patients enrolled, 25 were randomized to adjunctive povidone-iodine (mean age 48 [SD 16] years; 32% female) and 24 to control (mean age 43 [15] years; 33% female). Four (16%) participants discontinued 2.5% povidone-iodine prematurely due to intolerance. The proportion of participants with a positive culture during the initial 4 weeks of antiamoebic treatment was not significantly different in the povidone-iodine group (6/18 [33%] at 4 weeks) and control group (5/16 [31%] at 4 weeks) (RR 0.90, 95%CI: 0.35–2.29; P = 0.82). When used as an adjunctive to standard biguanide therapy, povidone-iodine did not markedly accelerate the clearance of Acanthamoeba organisms from the corneal surface over the initial month of therapy. This study is registered with ClinicalTrials.gov as NCT03484507 .

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This review examines the advancements in antimicrobial drug discovery with in vitro assays for Acanthamoeba, highlighting the efficacy of current topical antimicrobial agents. In recent decades, the treatment and diagnosis of Acanthamoeba keratitis (AK) have presented clinical challenges. Clinicians often rely on clinical judgment, risk factors, and patient travel history to guide initial treatment decisions. The clinical presentation of AK frequently coincides with bacterial and fungal keratitis, leading to delays in diagnostic confirmation. This review compiles a list of commonly used antimicrobial agents that may be useful in controlling and preventing Acanthamoeba and other microbial infections during the diagnostic waiting period. Due to their unique life cycle, consisting of both trophozoite and cyst stages, amoebae exhibit resistance to various clinical drugs. Current research efforts are focused on identifying alternative and effective treatment options. Despite the ongoing characterization of various cytocidal agents from natural and synthetic sources, chlorhexidine gluconate (CHG) and polyhexamethylene biguanide (PHMB) have emerged as the most effective therapies for AK. Drawing from previous studies, we catalog several commonly used antimicrobial agents that may enhance the efficacy of PHMB and CHG while also preventing other microbial infections. These alternative agents present promising options for treating AK cases. This review evaluates progress in anti-amoebic drug discovery, focusing on antibiotics and cataloging their activity at different stages of Acanthamoeba.

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The rise of antibiotic-resistant bacteria has become an alarming global health challenge. Disinfectants, such as alcohols, aldehydes, chlorine compounds, phenols, quaternary ammonium compounds (QACs), peroxides, and chlorhexidine, are widely used in healthcare settings as a critical line of defense against infection. Nevertheless, their overuse or misuse, especially at subinhibitory concentrations, can promote the emergence of bacterial resistance, potentially leading to cross-resistance to antibiotics. Several mechanisms, including efflux pump activation, alterations in membrane permeability, and biofilm formation, drive this process. A possible concern, although currently supported by limited and sometimes conflicting evidence-is that biocide-induced resistance might contribute indirectly to adverse clinical outcomes, such as treatment challenges, prolonged hospital stays, and increased healthcare costs. This review examines the molecular mechanisms of disinfectant-induced resistance, the epidemiological impact of multidrug-resistant (MDR) pathogens, and contemporary infection control strategies. Furthermore, the review evaluates the benefits and risks associated with disinfectant use, underscoring the necessity for optimized, evidence-based disinfection protocols to minimize the development of resistance while ensuring effective infection prevention.

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OBJECTIVE: The problem of hospital cross-infection due to contamination of disinfectants has been recognized elsewhere. The passage of bacteria through diluted disinfectants may not only bring about phenotypic changes in their antibiograms but also changes in phage susceptibility patterns. Contact with disinfectants in sublethal concentrations allows survival and multiplication of bacteria. METHODS AND MATERIALS: Serial passage, through disinfectants at subminimal inhibitory concentrations, induced antibiotic resistance in 18% of derived phenotypic variants of fifty strains of Pseudomonas aeruginosa which were isolated from diarrheal stools of infants in children's hospital. RESULTS: A proportion of these strains became susceptible to an increased number of antibiotics. The present study revealed that all the isolates were resistant to tetracycline and carbenicillin and 40% of these isolates became sensitive to both antibiotics after exposure to disinfectants. The exposure to disinfectants induced neomycin resistance among two isolates. The resistance patterns were three before disinfectants exposure which increased to be nine different patterns after exposure. No antibiotic resistance was transferred between P. aeruginosa and Escherichia coli K12 as a recipient strain. CONCLUSIONS: Almost 50% of the isolates tested became sensitive to tetracycline, carbenicillin and co-trimoxazole after exposure to disinfectants. The resistance patterns among the 50 isolates were three which changed to be nine different patterns after exposure to disinfectants. Unjustifiable use of disinfectants might give a chance for survival and multiplication of pathogenic bacteria to develop new resistance patterns to antibiotics in use with a short time. These new resistance variants of bacteria which multiply in hospital environment could lead to serious epidemic conflicts particularly the epidemiological reporting and management. OBJECTIVE: The problem of hospital cross-infection due to contamination of disinfectants has been recognized elsewhere. The passage of bacteria through diluted disinfectants may not only bring about phenotypic changes in their antibiograms but also changes in phage susceptibility patterns. Contact with disinfectants in sublethal concentrations allows survival and multiplication of bacteria. METHODS AND MATERIALS: Serial passage, through disinfectants at subminimal inhibitory concentrations, induced antibiotic resistance in 18% of derived phenotypic variants of fifty strains of Pseudomonas aeruginosa which were isolated from diarrheal stools of infants in children's hospital. RESULTS: A proportion of these strains became susceptible to an increased number of antibiotics. The present study revealed that all the isolates were resistant to tetracycline and carbenicillin and 40% of these isolates became sensitive to both antibiotics after exposure to disinfectants. The exposure to disinfectants induced neomycin resistance among two isolates. The resistance patterns were three before disinfectants exposure which increased to be nine different patterns after exposure. No antibiotic resistance was transferred between P. aeruginosa and Escherichia coli K12 as a recipient strain. CONCLUSIONS: Almost 50% of the isolates tested became sensitive to tetracycline, carbenicillin and co-trimoxazole after exposure to disinfectants. The resistance patterns among the 50 isolates were three which changed to be nine different patterns after exposure to disinfectants. Unjustifiable use of disinfectants might give a chance for survival and multiplication of pathogenic bacteria to develop new resistance patterns to antibiotics in use with a short time. These new resistance variants of bacteria which multiply in hospital environment could lead to serious epidemic conflicts particularly the epidemiological reporting and management.

Abstract licence: CC BY-NC