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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