Preoperative skin antiseptics for the prevention of cardiac implantable electronic device infections: chlorhexidine-alcohol versus povidone-iodine-alcohol.

Abstract

Background: Skin antisepsis plays a key role in the prevention of cardiac implantable electronic device (CIED) infections. Moreover, skin antisepsis by chlorhexidine-alcohol has not yet been fully evaluated.

Objectives: This single-center controlled study sought (1) to conduct a prospective observational analysis comparing two antiseptic skin preparations over two similar consecutive time periods, one conducted over a 1-year period using a povidone-iodine-alcohol solution (group I) and the other over the following year with a chlorhexidine-alcohol solution (group II) and (2) to determine real-life CIED infection predictive factors using the Prevention of Arrhythmia Device Infection Trial (PADIT) score.

Methods and results: CIED implantations were performed in 1689 patients. A total of 17 patients (1.01%) developed a CIED infection. Long-term follow-up (16 ± 13 months) revealed no significant differences between groups: infections were observed in 9/844 patients (1.07%) in group I versus 8/845 patients (0.95%) in group II (p = 0.99). Univariate and multivariate logistic regression analyses were performed to identify infectious risk factors. Adjusted odds ratios (ORs) and hazard ratios (HRs) were calculated. Univariate analyses revealed that infection occurrence was positively correlated with acute heart failure (OR: 3.55; 95%CI [1.24-9.37]; p = 0.01 and HR: 3.37; 95% CI [1.28-8.87]; p = 0.014), renal failure (OR: 2.71; 95% CI [0.88-8.42]; p = 0.08 and HR: 2.99; 95% CI [0.97-9.17]; p = 0.05), use of temporary pacing before the implantation procedure (OR: 4.45; 95% CI [1.003-20.3]; p = 0.04 and HR: 4.35; 95% CI [0.99-19.05]; p = 0.05), PADIT score (OR: 1.3; 95% CI [1.064-1.54]; p = 0.009 and HR: 1.27; 95% CI [1.052-1.53]; p = 0.013), and PADIT score ≥ 5 (OR: 4.185; 95% CI [1.6-10.9]; p = 0.003 and HR: 3.91; 95% CI [1.51-10.149]; p = 0.005). No clear significant difference was found regarding the antiseptic skin preparation choice (OR: 0.88; 95% CI [0.34-2.3]; p = 0.8 and HR: 1.11; 95% CI [0.416-2.98]; p = 0.82). In multivariate analysis, the PADIT score ≥ 5 (OR: 3.18; 95% CI [1.125-8.99]; p = 0.003 and HR: 3.052; 95% CI [1.089-8.55]; p = 0.034) and use of temporary pacing before the implantation procedure (OR: 8.44; 95% CI [1.68-42.34]; p = 0.01 and HR: 8.49; 95% CI [1.732-41.69]; p = 0.008) were negatively correlated with the device infection risk.

Conclusion: This study found that chlorhexidine-alcohol and povidone-iodine-alcohol solutions displayed similar antiseptic effects regarding CIED infection prevention. Both use of temporary pacing before the implantation procedure and PADIT score ≥ 5 correlated with the device infection risk.