The impact of changing antiseptic skin preparation agent used for cardiac implantable electronic device (CIED) procedures on the risk of infection.
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.


CONCLUSION
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.
['Qintar|Mohammed|M|', 'Zardkoohi|Omeed|O|', 'Hammadah|Muhammad|M|', 'Hsu|Amy|A|', 'Wazni|Oussama|O|', 'Wilkoff|Bruce L|BL|', 'Tarakji|Khaldoun G|KG|']
D000279:Administration, Cutaneous D017677:Age Distribution D000368:Aged D000891:Anti-Infective Agents, Local D015331:Cohort Studies D017147:Defibrillators, Implantable D005260:Female D006801:Humans D015994:Incidence D008297:Male D009820:Ohio D010138:Pacemaker, Artificial D011292:Premedication D019919:Prosthesis Implantation D016459:Prosthesis-Related Infections D012189:Retrospective Studies D018570:Risk Assessment D017678:Sex Distribution D016896:Treatment Outcome
Cardiac implantable electronic device infection complication defibrillator pacemaker outcome