The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections

Dhanunjaya Lakkireddy, Srilaxmi Valasareddi, Kay Ryschon, Krishnamohan Basarkodu, Karen Rovang, Syed M. Mohiuddin, Tom Hee, Robert Schweikert, Patrick Tchou, Bruce Wilkoff, Andrea Natale, Huagui Li

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)789-794
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume28
Issue number8
DOIs
StatePublished - Aug 2005

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Povidone-Iodine
Defibrillators
Equipment and Supplies
Infection
Implantable Defibrillators
Demography
Antibiotic Prophylaxis
Iodine
Staphylococcus aureus
Hypersensitivity
Anti-Bacterial Agents
Physicians

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections. / Lakkireddy, Dhanunjaya; Valasareddi, Srilaxmi; Ryschon, Kay; Basarkodu, Krishnamohan; Rovang, Karen; Mohiuddin, Syed M.; Hee, Tom; Schweikert, Robert; Tchou, Patrick; Wilkoff, Bruce; Natale, Andrea; Li, Huagui.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 28, No. 8, 08.2005, p. 789-794.

Research output: Contribution to journalArticle

Lakkireddy, D, Valasareddi, S, Ryschon, K, Basarkodu, K, Rovang, K, Mohiuddin, SM, Hee, T, Schweikert, R, Tchou, P, Wilkoff, B, Natale, A & Li, H 2005, 'The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections', PACE - Pacing and Clinical Electrophysiology, vol. 28, no. 8, pp. 789-794. https://doi.org/10.1111/j.1540-8159.2005.00173.x
Lakkireddy, Dhanunjaya ; Valasareddi, Srilaxmi ; Ryschon, Kay ; Basarkodu, Krishnamohan ; Rovang, Karen ; Mohiuddin, Syed M. ; Hee, Tom ; Schweikert, Robert ; Tchou, Patrick ; Wilkoff, Bruce ; Natale, Andrea ; Li, Huagui. / The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections. In: PACE - Pacing and Clinical Electrophysiology. 2005 ; Vol. 28, No. 8. pp. 789-794.
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abstract = "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.",
author = "Dhanunjaya Lakkireddy and Srilaxmi Valasareddi and Kay Ryschon and Krishnamohan Basarkodu and Karen Rovang and Mohiuddin, {Syed M.} and Tom Hee and Robert Schweikert and Patrick Tchou and Bruce Wilkoff and Andrea Natale and Huagui Li",
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T1 - The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections

AU - Lakkireddy, Dhanunjaya

AU - Valasareddi, Srilaxmi

AU - Ryschon, Kay

AU - Basarkodu, Krishnamohan

AU - Rovang, Karen

AU - Mohiuddin, Syed M.

AU - Hee, Tom

AU - Schweikert, Robert

AU - Tchou, Patrick

AU - Wilkoff, Bruce

AU - Natale, Andrea

AU - Li, Huagui

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N2 - 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.

AB - 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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