Key result
Povidone-iodine pocket irrigation did not significantly alter the rate of pocket infections compared to saline irrigation (0.7% vs 0.6%, p=ns) after pacemaker or defibrillator implantation.
Why the study?
Does povidone-iodine pocket irrigation reduce the rate of pocket infection in patients receiving implantable pacemakers or defibrillators?
Cohort (n=2,564)
Does povidone-iodine pocket irrigation reduce the rate of pocket infection in patients receiving implantable pacemakers or defibrillators?
Povidone-iodine irrigation of the subcutaneous pocket does not significantly alter the rates of pocket infection after pacemaker or defibrillator implantation compared to saline irrigation.
Answers are grounded in this paper and cite their sources.
Povidone-iodine irrigation was not associated with lower infection rates; leaves open its role and should not change current practice.
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. CONCLUSION: Povidone-iodine irrigation of the subcutaneous pocket did not alter the rates of pocket infection after pacemaker/defibrillator implantation.
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Lakkireddy et al. (2005) conducted a cohort in Pacemaker and defibrillator implantation (n=2,564). Povidone-iodine pocket irrigation vs. Saline pocket irrigation was evaluated on Pocket infections (p=ns). Povidone-iodine pocket irrigation did not significantly alter the rate of pocket infections compared to saline irrigation (0.7% vs 0.6%, p=ns) after pacemaker or defibrillator implantation.
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