Antimicrobial resistance has been described as a major threat to health by the World Health Organization (WHO). The six ESKAPE pathogens namely Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp are the leading etiopathogens in nosocomial infections worldwide. With increasing prevalence of antimicrobial resistance, the ESKAPE bacteria are also becoming multidrug resistant. Overuse and indiscriminate use have led to increasing resistance to topical antibiotics such as fusidic acid and mupirocin. Because of their broad spectrum of antimicrobial activity, antiseptics are beneficial in wound care and may be helpful in treating infections caused by the ESKAPE pathogens. However, their use is not without challenges. Tolerability, inactivation by organic matter and the emergence of antimicrobial resistance/cross-resistance are some of the concerns with antiseptics. While biofilms are highly prevalent in chronic wounds, the ESKAPE pathogens have also been implicated in biofilm formation in acute wounds. In this article, the authors have discussed the major challenges in antisepsis such as antimicrobial efficacy, antiseptic resistance, antibiotic and antiseptic cross-resistance, wound healing and tolerability. They have compared the widely used antiseptic povidone-iodine (PVP-I) with other commonly used antiseptics like chlorhexidine gluconate, polyhexanide and octenidine with regard to antimicrobial activity and the effect of presence of organic material on the  efficacy of the antiseptic.

Compared with the other three commonly-used antiseptics, PVP-I had the broadest spectrum of antimicrobial activity. Besides activity against bacteria, viruses, PVP-1 also has activity against actinobacteria and bacterial spores, a characteristic not seen in other antiseptics examined in this study. PVP-I acts on several bacterial targets, unlike chlorhexidine, which acts on only one bacterial target. Hence, no resistance or antibiotic cross-resistance has been reported with PVP-I despite its widespread use for decades. It has activity against all ESKAPE pathogens and also effectively eliminated biofilms. PVP-I exhibits rapid antibacterial action even in the presence of organic material like blood. It promotes wound healing by enhancing transforming growth factor (TGF)-beta expression. The other noteworthy features of PVP-I include its low allergenic potential and low cytotoxicity. Based on these properties, PVP-I is “a highly desirable antiseptic in the management of wounds and nosocomial infections”.

Barreto R, et al. Int J Antimicrob Agents. 2020 Sep;56(3):106064