聚维酮碘囊袋冲洗在起搏器和除颤器感染方面的影响。
The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections.
作者信息
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
机构信息
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
出版信息
Pacing Clin Electrophysiol. 2005 Aug;28(8):789-94. doi: 10.1111/j.1540-8159.2005.00173.x.
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.
背景
感染是永久性心脏起搏器（PM）和植入式心脏复律除颤器（ICD）的一种严重并发症。许多植入医生在植入设备前通常使用聚维酮碘溶液冲洗设备袋。我们试图评估这种措施是否会改变感染率。
方法
对1994年至2002年间连续接受植入式PM或ICD设备的2564例患者进行研究。53%的患者使用聚维酮碘进行袋内冲洗，47%的患者使用生理盐水。共有18例（0.7%）患者发生袋内感染，聚维酮碘冲洗组（I组）为0.7%（10/1359），生理盐水冲洗组（II组）为0.6%（8/1205）（p=无统计学意义）。对I组和II组进行了结果部分所述的各种临床和人口统计学变量的研究。
结果
I组和II组的基线人口统计学和临床特征分别无统计学差异。ICD比PM更容易感染（56%对44%）。大多数（83%）设备为双腔。因更换导线或发生器而重新打开袋的感染发生率高于新植入（61%对39%）。植入前预防性使用抗生素的情况无差异。晚期（61%）和深部袋内感染（78%）比早期（39%）和浅表感染（22%）更常见。血培养阳性率为67%，金黄色葡萄球菌是最常见的病原体（50%）。诊断设备感染后抗生素使用的平均持续时间为35±23天，72%的患者需要取出设备。56%的病例在对侧重新植入设备。每组各有1例患者因设备感染及相关并发症死亡。两组均未发现对碘有明显过敏反应。
结论
起搏器/除颤器植入后，皮下袋用聚维酮碘冲洗不会改变袋内感染率。
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