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Grand Rounds

RCT Results: Chlorhexidine vs Povidone-Iodine for Urogyn Surgery

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BACKGROUND AND PURPOSE:

  • Iodine only FDA approved antiseptic agent for vaginal surgery
  • ACOG gives option of chlorhexidine gluconate or povidone-iodine
  • Rockefeller et al. (AJOG, 2022) compared the effectiveness of chlorhexidine vs iodine as presurgical vaginal antiseptic solutions for the prevention of urinary tract infection (UTIs) following urogynecologic surgeries

METHODS:

  • Randomized controlled noninferiority trial
  • Participants
    • Women undergoing urogynecologic surgery
  • Interventions
    • 2% Chlorhexidine
    • 10% Iodine
  • Study design
    • Patients masked to intervention
    • All patients received standard antibiotic prophylaxis
    • Sample size calculation: 58 participants were required per arm to demonstrate noninferiority of chlorhexidine vs iodine
    • Margin of relative risk of <1.5 for the upper limit of 95% confidence interval
  • Primary outcome
    • Symptomatic urinary tract infection within 2 weeks after surgery
  • Secondary outcomes
    • Culture-proven UTI at 2 and 6 weeks after surgery
    • Symptomatic UTI at 6 weeks after surgery
    • Any surgical site infection at 2 weeks after surgery
    • Patient-reported vaginal irritation after surgery

RESULTS:

  • Chlorhexidine: 61 participants | Iodine: 58 participants
    • No differences: Demographic characteristics | Medical history | Type of urogynecologic operation performed | Perioperative factors
  • Chlorhexidine was not inferior to iodine at reducing symptomatic urinary tract infection within 2 weeks of surgery
    • Chlorhexidine: 10%
    • Iodine: 17%
    • Relative risk 0.6 (95% CI, -∞ to 1.3)
  • Chlorhexidine was also not inferior to iodine for the secondary UTI outcomes
  • Groups were similar in terms of
    • Surgical site infection: overall 2.5%
    • Presence of any vaginal irritation: 7.4% for both groups

CONCLUSION:

  • Chlorhexidine was found to be noninferior to iodine at preventing urinary tract infection when used as a vaginal antiseptic prior to urogynecologic surgery
  • Chlorhexidine is probably a safe and effective alternative to iodine for vaginal antisepsis, though additional studies should examine surgical site infections
  • The authors state

Based on this information, it would seem that either CHG or iodine would be an appropriate perioperative antiseptic agent

Learn More – Primary Sources:

Chlorhexidine gluconate vs povidone-iodine vaginal antisepsis for urogynecologic surgery: a randomized controlled noninferiority trial

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Related ObG Topics:

Povidone Iodine or Chlorhexidine for Hysterectomy Prep: Results from a Large Cohort Study
Chlorhexidine or Povidone-Iodine for Vaginal Cleansing Prior to Cesarean Delivery?
Chlorhexidine or Iodine Based Skin Prep for Cesarean Sections?

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