Şeyhmus YİĞİT, Mehmet Sait AKAR, Erdal ÖZBEK

Ortopedik Enfeksiyonların Tedavisinde Sodyum Hipoklorit’in Yeri Var mıdır?

Amaç: Ortopedik cerrahide periprostetik, eklem (septik artrit) ve diabetik yara enfeksiyonlar tedavisi zor ve uzun zaman almaktadır. Bakteriler tarafından artan antibiyotik direnci nedeniyle lokal antiseptikler her geçen gün daha fazla önem kazanmışlardır. Bu çalışmanın amacı, sodyum hipoklorit ve günlük ortopedik pratikte sıkça kullanılan povidin iyot gibi bakterisidal dezenfektanın biofilm oluşturan S. aureus, S. epidermidis, E.coli, P. aeruginosa suşları üzerinde etkinliğini değerlendirmektir. Yöntemler: Bu çalışmada, dezenfektan olarak %0,08’lik sodyum hipoklorit (HYPNOS, Türkiye), %3,5 povidoniyot (ORBAK Kimya, Türkiye), test edilen mikroorganizmalar ise Staphylococcus aureus ATCC 6538, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC-15442 suşları kullanılmıştır. Dezenfektanların etkinliğini saptamak için Kelsey-Sykes metodu modifiye edilerek kullanılmıştır. Her bir mikroorganizmadan ayrı ayrı bakteri süspansiyonu hazırlanmıştır. Tüpler 35°C’de 48 saat bekletilmiştir. 48 saatlik inkubasyondan sonra tüplerden 0.01 ml özelerle %5 koyun kanlı agar (RTA© İstanbul, TR) besiyerlerine pasaj yapılarak 24 saat 35°C’de inkube edilmiştir. 24 saatin sonunda plaklar üreme yönünden değerlendirilmiştir. Bulgular: Sodyum hipoklorit (%0,08’) ile 2 dk maruziyet sonucu S. aureus, S.epidermidis, E. coli suşlarındaki bakterilerin tamamı ölürken,P. aeruginosa suşundaki bakterilerin bir kısmı yaşamış ve kültürde yeniden üreme olmuştur. Povidon iyot (%0,35) ile 2 dk maruziyet sonucu S. aureus ve S.epidermidis suşlarındaki bakterilerin tamamı ölürken, E. coli ve P. aeruginosa suşundaki bakterilerin bir kısmı yaşamış ve kültürde yeniden üreme olmuştur. Sodyum hipoklorit (%0,08’) ve Povidon iyot (%0,35) ile 5 dk maruz kalındığında tüm bakteri suşlarının öldüğünü saptadık. Sonuç: Sodyum hipoklorit güçlü bakterisidal etkiye sahiptir ve çok ilaca dirençli organizmaların eklem dışı yüzeyel veya periprostetik enfeksiyonlarında kullanılabilir. Doku toksitesi için ek çalışmalara ihtiyaç vardır.

Does Sodium Hypochlorite Have a Place in the Treatment of Orthopedic Infection?

Objective: In orthopedic surgery, treatment of periprosthetic, joint (septic arthritis) and diabetic wound infections are difficult and takes a long time. Due to the increased antibiotic resistance by bacteria, local antiseptics have gained more importance day by day. The aim of this study is to evaluate the efficacy of bactericidal disinfectants such as sodium hypochlorite and povidin iodine, which are frequently used in daily orthopedic practice, on strains of S. aureus, S. epidermidis, E.coli, P. aeruginosa. Methods: In this study, 0.08% sodium hypochlorite (HYPNOS, Turkey) and 0.35% povidoniyot (ORBAK Chemistry, Turkey) as a disinfectant , the test microorganisms are Staphylococcus aureus ATCC 6538, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC- 15442 strains were used. The Kelsey-Sykes method with modified was used to determine the effectiveness of disinfectants. Separate bacterial suspension was prepared from each microorganism. Tubes were kept at 35 ° C for 48 hours. After 48 hours of incubation, passages of 5% sheep blood agar (RTA © Istanbul, TR) with 0.01 ml extracts from tubes were incubated at 35 ° C for 24 hours. At the end of 24 hours, plates were evaluated for reproduction. Results: All of the bacteria in S. aureus, S.epidermidis, E. coli strains died after 2 min exposure with sodium hypochlorite (0.08%). Some of the bacteria in the aeruginosa strain lived and reproduced in culture.As a result of 2 min exposure with povidone iodine (0.35%), all bacteria in S. aureus and S.epidermidis strains died, while some of the bacteria in E. coli and P. aeruginosa strain lived and reproduced in culture. We detected that all bacterial strains died when exposed to sodium hypochlorite (0.08%) and Povidone iodine (0.35%) for 5 minutes. Conclusions: Sodium hypochlorite has a strong bactericidal effect and can be used in extra-articular superficial or periprosthetic infections of multidrug-resistant organisms. Additional studies are needed for tissue toxicity.

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