title: The impact of changing antiseptic skin preparation agent used for cardiac implantable electronic device (CIED) procedures on the risk of infection.
abstract: BACKGROUND
  Cardiac implantable electronic device (CIED) infection is a major complication that is associated with increased morbidity and mortality. Recent data suggested a relationship between the antiseptic agent used for skin preparation at time of CIED procedure and risk for infection.
  
  
  METHODS
  On April 30, 2011, we changed the antiseptic agent used for skin preparation at our tertiary care facility from chlorhexidine-alcohol to povidone-iodine for all CIED procedures. We retrospectively reviewed records of all patients who underwent CIED procedure 1 year before and after the change. CIED infection was defined as pocket or endovascular systemic infection that required removal within 1 year of the index procedure. We examined if the change affected the risk of CIED infection.
  
  
  RESULTS
  A total of 2,792 patients underwent 2,840 CIED procedures; 1,748 (61.5%) had implantable cardioverter defibrillator procedures and 1,092 (38.4%) had permanent pacemaker procedures. Chlorhexidine-alcohol agent was used in 1,450 (51.1%) procedures, and povidone-iodine agent was used in 1,390 (48.9%). After 1 year of follow-up, 31 patients (1.09%) developed CIED infection that required system removal. The 1-year infection rate was 1.1% among both antiseptic agent groups and there were no significant differences in the infection presentations among both groups (P = 0.950). Multivariate Cox proportional hazards regression model showed that risk factors for infection within 1 year included age, diabetes, and African American race.
  
  
  CONCLUSIONS
  In one large cohort of patients undergoing CIED procedures, the antiseptic agent used for skin preparation (chlorhexidine-alcohol vs povidone-iodine) was not associated with increased risk of developing CIED infection.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Qintar
authors.forename: Omeed
authors.initials: O
authors.lastname: Zardkoohi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hammadah
authors.forename: Amy
authors.initials: A
authors.lastname: Hsu
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: Khaldoun G
authors.initials: KG
authors.lastname: Tarakji
mesh_terms: D000279:Administration, Cutaneous; D017677:Age Distribution; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011292:Premedication / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local
keywords: Cardiac implantable electronic device; complication; defibrillator; infection; outcome; pacemaker