Cement Shortage Lakkireddy, Et Al.

Cement Shortage

Lakkireddy, et al. (2005) examined the effect of Povidone-iodine pocket irrigation on the rate of infection from permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs). Compared with a control group that received PMs or ICDs irrigated in saline solution, the patients whose devices were irrigated with Povidone-iodine did not experience a lower rate of infection. Povidone-iodine pocket irrigation is, however, commonly used as a preventative measure against the infections that may occur after implantation. The substance is an antiseptic also known as Betadine.

The Lakkireddy et al. (2005) study was comprehensive, involving over 2500 patients over an eight-year period. Slightly less than half of the patients received saline irrigation in the pocket and slightly more than half of the patients' pockets were irrigated with Povidone-iodone. Contrary to the hypothesis, there were no significant differences in the rate of infection between the two groups.

About one-third of all the patients who did experience infection had diabetes. Therefore, other intervening factors may have affected the development of the infection regardless of the whether the pocket was irrigated with the Povidone-iodine or not. Infections were treated immediately with a course of antibiotics but some complications did arise including one patient death as the result of septic shock.

Lakkireddy et al. (2005) note that implanting PMs, ICDs or any other invasive device demands the strictest aseptic procedures. Povidone-iodine is one way to topically irrigate the pocket before implantation as a means to prevent infection. Combined with antibiotics, the Povidone-iodine irrigation may prevent complications but antibiotics may be contraindicated.

The authors questioned the role of Povidone-iodine vs. other antiseptics, noting that no detailed survey like the current one had ever been conducted on a large patient population. Furthermore, the authors claim that pocket infection rates have decreased in general worldwide and especially in institutions with strict procedural guidelines. Moreover, Lakkireddy et al. (2005) note that many of the infections were superficial, due to surface wounds from the surgery and not from the deep pocket itself. Superficial wounds can be readily prevented via standard hygienic procedures used during the surgical process. Lakkireddy et al. (2005) conclude that Povidone-iodine irrigation does not in itself prevent infections but fail to outline the possible implications of the findings.

Although internally valid, the Lakkireddy et al. (2005) study has significant limitations that prevent generalization. Patients were culled from one institution. Surgical procedures were not standardized and could have varied widely from doctor to doctor. In fact, the Povidone-iodine solutions were not standardized either. Most importantly, the researchers were not able to determine whether a course of prophylactic antibiotics administered prior to implantation affected the rates of infection. In fact, the antibiotics might have had a major bearing on the rates of infection and could abnegate the results of the current study.