Cadexomer iodine proves effective in reducing pin tract infections during external fixation treatment: Study
The use of cadexomer iodine ointment during Knee joint distraction (KJD) results in a significant reduction of the number of patients experiencing pin tract infections during treatment, according to their study published in the Journal of Experimental Orthopaedics.
Knee joint distraction (KJD) is a joint-preserving treatment for younger (< 65 years) patients with severe knee osteoarthritis (OA). KJD aims to postpone total knee arthroplasty (TKA) and decrease the chance of a revision TKA later in life. 1
Despite positive results that were observed in trials of KJD and regular care, the treatment can be a 6-week burden for patients when pin tract skin infections occur. 2 Pin tract infections are often seen in external fixation devices, and while a small number of studies have been published on how to prevent these infections, the literature on this topic is limited.
Therefore, Mylène P. Jansen and colleagues from the Department of Rheumatology Clinical Immunology, University Medical Center Utrecht, The Netherlands included the use of cadexomer iodine ointment in the KJD wound care protocol in regular care. In their study, they clearly stated their objective to evaluate whether using cadexomer iodine ointment reduced the number of patients with pin tract infections during KJD treatment.
The authors included a total of sixty-seven patients in the study out of which 34 patients used cadexomer iodine and 33 patients did not. All of them were treated with KJD in regular care only if they gave consent for use of their data. All patients followed a wound care protocol, which since March 2019 included the use of cadexomer iodine ointment.
For the purpose of their research, they used Cadexomer ointment that consists of small cadexomer (polysaccharide) beads containing 0.9% iodine that can absorb wound exudate, pus and debris. 3 The absorption causes the beads to swell, allowing a sustained release of iodine. As more iodine is released, the color gradually changes from brown to white/gray, indicating the ointment is no longer effective and wound care should be performed.
Except for the use of Cadexomer Iodine ointment, the advised wound care protocol was identical for all patients. All were instructed to perform a procedural wound care every 1 to 3 days.
However, the distraction treatment protocol for all patients was recommended for at least 5 mm for 6 to 7 weeks, using an external fixation frame that consisted of 2 distraction tubes, 1 placed medially and 1 laterally of the knee joint. The tubes were fixed to the bones using 8 trans- cutaneous half pins, placed in pairs at 4 locations, describes Jansen.
The authors further studied the number of patients experiencing pin tract infections comparing patients who did (March 2019–December 2019) and did not (November 2017– March 2019) use the ointment.
The following keynote observations were highlighted-
a. Patient who did not use cadexomer iodine experienced twice as many infections (64% vs 32%) (64% vs 32%; p = 0.010)..
b. There was a significant difference in the number of patients with serious infections, requiring more antibiotics than the standard 7-day oral antibiotics (30% without vs 6% with cadexomer iodine; p = 0.009).
c. The number of patients experiencing infections after frame removal did not differ significantly between groups (6% without Cadexomer Iodine vs 9% with Cadexomer Iodine; p = 0.667).
Based on the results of the study, the researchers noted that most important finding of the present study was that for patients treated with KJD, incorporating the use of cadexomer iodine ointment in the wound care protocol significantly reduces the prevalence of pin tract infections.
"The use of cadexomer iodine ointment during KJD results in a significant reduction of the number of patients experiencing pin tract infections during treatment in regular care. Use of this ointment may be considered as standard protocol during KJD treatment and could be of value in general external fixator usage as well," they concluded
The above article has been published by Medical Dialogues under the MD Brand Connect Initiative. For more details on Cadexomer Iodine, click here
References
1. Intema F, Van Roermund PM, Marijnissen ACA, Cotofana S, Eckstein F, Castelein RM et al (2011) Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis 70(8): 1441–1446.
2. Jansen MP, Mastbergen SC, van Heerwaarden RJ, Spruijt S, van Empelen MD, Kester EC et al (2020) Knee joint distraction in regular care for treatment of knee osteoarthritis: a comparison with clinical trial data. PLoS One 15(1):e0227975.
3. Malone M, Johani K, Jensen SO, Gosbell IB, Dickson HG, McLennan S et al (2017) Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo. J Antimicrob Chemother 72(7):2093–2101.
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