Prevention of Cardiac Implantable Electronic Device–Related Infection in Patients With Cancer: The Role of a Comprehensive Prophylactic Bundle Approach That Includes the Antimicrobial Mesh

Abstract

Background Oncological patients have several additional risk factors for developing a cardiac implantable electronic device (CIEDs)-related infection. Therefore, we evaluated the clinical impact of our comprehensive bundle approach that includes the novel minocycline and rifampin antimicrobial mesh (TYRX) for the prevention of CIED infections in patients living with cancer. Methods We retrospectively reviewed all consecutive patients who had a CIED placement at our institution during 2012 through 2017, who received preoperative vancomycin, intraoperative pocket irrigation with bacitracin and polymyxin B, plus TYRX antimicrobial mesh, followed by postoperative oral minocycline. Results A total of 154 patients had a CIED, with 97 permanent pacemakers (PPM), 23 implantable cardioverter defibrillators (ICD), and 34 cardiac resynchronization therapy (CRT) devices. An underlying solid cancer was present in 62% of patients, while 38% had a hematologic malignancy. Apart from a higher proportion of surgical interventions in the PPM group than in the ICD and CRT groups (p=0.007), no other oncologic variables were statistically significantly different between groups. Despite an extensive median follow-up period of 21.9 months (interquartile range, 6.7-33.8), 16 patients (10%) had a mechanical complication, while only 2 patients (1.3%) developed a CIED infection, requiring the device to be explanted. Conclusion Our comprehensive prophylactic bundle approach using TYRX antimicrobial mesh in an oncologic population at high risk for infections was revealed upon extensive follow-up to be both safe and effective in maintaining the rate of CIED infection at 1.3%, well within published averages in the broader population of CIED recipients.

Prevention of device‐related infections in patients with cancer: Current practice and future horizons

“…Therefore, selecting a high‐risk population for infection, such as an oncological population with several risk factors, would likely decrease the number needed to treat and improve the cost effectiveness of the envelope, which is priced slightly below $1000 106,107 . At our institution, all patients who have cancer receive the TYRX envelope as part of a comprehensive prophylactic bundle, which has been demonstrated to be both safe and effective in maintaining a low rate of CIED infection (1.3%) and is well within published averages in the broader population of all CIED recipients 108 …”

“…106,107 At our institution, all patients who have cancer receive the TYRX envelope as part of a comprehensive prophylactic bundle, which has been demonstrated to be both safe and effective in maintaining a low rate of CIED infection (1.3%) and is well within published averages in the broader population of all CIED recipients. 108 Of note, few studies have evaluated novel techniques for decreasing microbial adherence to CIEDs. Polyurethane has been shown to have a higher affinity for biofilm-producing pathogens than titanium in vitro.…”

“… 106 , 107 At our institution, all patients who have cancer receive the TYRX envelope as part of a comprehensive prophylactic bundle, which has been demonstrated to be both safe and effective in maintaining a low rate of CIED infection (1.3%) and is well within published averages in the broader population of all CIED recipients. 108 …”

Measures to Prevent Infection in Cardiac Implantable Electronic Device Replacements or Upgrades

“…The study demonstrated a non-increased risk of CIED infections within an oncologic population, including patients with solid and hematologic tumors. As such, it was concluded that there is no compelling justification for withholding the placement of a CIED from oncological patients solely on the grounds of infection risk [ 18 ].…”

Implant-Associated Infections: A Review of the Safety of Cardiac Implants

“…The comprehensive bundle approach that recommends the use of novel minocycline and rifampicin antimicrobial mesh (TYRX) to prevent the IAIs in patients suffering from both solid organ and hematologic malignancies with CIED was reported recently [ 39 ]. Such an approach was previously confirmed as an important strategy to prevent cardiac IAIs as evidenced by the results of the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial (WRAP-IT).…”