Sources used in this document:

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.

However, Lakkireddy et al. (2005) do draw attention to the need for hygienic, aseptic surgical procedures including the use of topical antiseptics like Povidone-iodine. Especially when devices like PMs and ICDs are being implanted, the potential for infection rises. A more informative study might reveal which patient populations are at the highest risk of developing staph or other infections. Those patients who are the most at risk might benefit the most from prophylactic antibiotics as well as standardized, sterilized surgical procedures.