The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections.
BACKGROUND
Infection is a devastating complication of permanent pacemakers (PMs) implantable cardioverter defibrillators (ICDs). Many implanting physicians commonly use povidone-iodine solution to irrigate the device pocket before implanting the device. We sought to assess if such a measure would alter the rate of infection.


METHODS
A total of 2,564 consecutive patients who received implantable PM or ICD devices between 1994 and 2002 were studied. Povidone-iodine was used for pocket irrigation in 53% and saline in 47%. A total of 18 (0.7%) patients developed pocket infections with 0.7% (10/1,359) in povidone-iodine (group I) and 0.6% (8/1,205) in saline (group II) pocket irrigation (p = ns). Groups I and II were studied for various clinical and demographic variables described in the results section.


RESULTS
There was no statistical difference in the baseline demographic and clinical characteristics between groups I and II, respectively. ICDs were most frequently infected than PMs (56% vs 44%). Most (83%) of the devices were dual chamber. Reopening of the pocket for either lead or generator replacement had a higher incidence of infection than new implants (61% vs 39%). There was no difference in the use of preimplantation antibiotic prophylaxis. Late (61%) and deep pocket infections (78%) were more common than early (39%) and superficial infections (22%). Blood cultures were positive in 67% and Staphylococcus aureus was the common most pathogen (50%). The mean duration of antibiotics use after the diagnosis of device infection was 35 +/- 23 days with 72% requiring device explantation. The device was reimplanted on the contralateral side in 56% cases. One patient in each group died due to device infection and related complications. No significant allergy to iodine was seen in either group.


CONCLUSIONS
Povidone-iodine irrigation of the subcutaneous pocket did not alter the rates of pocket infection after pacemaker/defibrillator implantation.
Lakkireddy
Dhanunjaya
D
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Valasareddi
Srilaxmi
S
Ryschon
Kay
K
Basarkodu
Krishnamohan
K
Rovang
Karen
K
Mohiuddin
Syed M
SM
Hee
Tom
T
Schweikert
Robert
R
Tchou
Patrick
P
Wilkoff
Bruce
B
Natale
Andrea
A
Li
Huagui
H
D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011206:Povidone-Iodine / Q000008:administration & dosage*; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D012965:Sodium Chloride; D011206:Povidone-Iodine