Preoperative skin antiseptics for prevention of cardiac implantable electronic device infections: a historical-controlled interventional trial comparing aqueous against alcoholic povidone-iodine solutions.
OBJECTIVE
Local skin antiseptic prevention against cardiac implantable electronic device (CIED) infections is not yet fully understood. This monocentre historical-controlled study sought to (i) conduct a prospective observational analysis comparing two antiseptic skin preparations over two similar consecutive periods of time, one conducted over a 1-year period using an aqueous povidone-iodine solution (Group I) and the other over the following with an alcoholic povidone-iodine solution (Group II); (ii) determine the predictive factors of CIED infection.


RESULTS
Cardiac implantable electronic device implantation was performed in 1326 patients (pts). A total of 32 pts (2.4%) developed a CIED infection. Long-term follow-up (26 ± 3 months) revealed no significant difference between the groups: infections were observed in 14 of the 648 pts (2.2%) in Group I vs. 18 of the 678 pts (2.7%) in Group II (P = 0.9). Single- and multiple-variable logistic regression analyses were performed to identify risk factors; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. The occurrence of infection was positively correlated with re-intervention (aOR, 7.16; 95% CI, 2.56-19.99; P < 0.0001), number of generator replacements, mean (aOR, 3.47; 95% CI, 2.22-5.44; P < 0.001), and haematoma (aOR, 48.4; 95% CI, 13.45-174.25; P < 0.0001).


CONCLUSIONS
This study found that aqueous and alcoholic povidone-iodine solutions displayed similar antiseptic effects regarding CIED infection prevention. Independent predictive factors of CIED infection were re-intervention, haematoma, and number of generator replacements.
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France dakosta@orange.fr.
Antoine
A
Da Costa
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Claire
C
Tulane
Neurology Unit D, Memory Research Centre, University Medical Hospital P.-Wertheimer, Lyon, France.
Virginie
V
Dauphinot
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Jérémy
J
Terreaux
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Cécile
C
Romeyer-Bouchard
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Alexie
A
Gate-Martinet
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Marie
M
Levallois
The Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne F-42000, France.
Karl
K
Isaaz
D000279:Administration, Cutaneous; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D000431:Ethanol / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000737:chemistry; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017192:Skin Diseases, Bacterial / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014867:Water / Q000737:chemistry
D014867:Water; D000431:Ethanol; D011206:Povidone-Iodine
Alcoholic povidone-iodine; Antiseptic agents; Aqueous povidone-iodine; Cardiac implantable electronic device; Implantation; Infection; Risk factors; Trial