Use of elemental iodine for shunt infection prophylaxis

OBJECTIVE: Elemental iodine (I₂) can kill a broad spectrum of organisms, including bacteria, fungi, and viruses. Furthermore, it is inexpensive, bacterial resistance is unknown, and allergic reactions are rare. Because of these properties, we wanted to determine the concentration of I₂ that would kill Staphylococcus epidermidis and Staphylococcus aureus without causing injury to the central nervous system, in an attempt to further reduce the rates of shunt infections. METHODS: Bacterial kill studies using S. epidermidis and S. aureus were performed by using Ringer's lactate solution alone or solution containing I₂ at a concentration of 5, 10, 20, 50, 100, or 1000 parts per million (ppm), cefazolin at 1 mg/ml, or bacitracin at 100 units/ml. Twenty-one adult male Wistar rats, in seven groups, underwent a frontoparietal craniectomy. The surfaces of their brains were irrigated for 1 hour with Ringer's lactate solution alone or solution containing I₂ (at the concentrations noted above). After 72 hours of observation, the animals were killed. Their brains were then fixed in formalin, stained with hematoxylin/eosin, and examined. RESULTS: Even with exposure of only 15 seconds to an I₂ solution of 20 ppm, no growth was detected with an inoculum of either bacteria of 100 million. In contrast, the two antibiotics were not nearly as effective as I₂, with kill rates ranging from 19 to 93%. Examination of the rat brains demonstrated no histological changes after subarachnoid exposure to solutions containing 5, 10, 20, or 50 ppm; however, necrosis was observed with concentrations of 100 and 1000 ppm. CONCLUSION: I₂ can be added to irrigation solutions in sufficient concentrations to be bactericidal without causing any central nervous system injury.