Role of antibiotic envelopes in preventing cardiac implantable electronic device infection: A meta‐analysis of 14 859 procedures

Abstract

Introduction:We conducted an updated meta-analysis assessing the role of antibiotic envelopes in preventing Cardiac implantable electronic devices (CIED)-related infections as compared to standard infection prevention strategies. Methods:A systematic search was conducted on Medline/PubMed and EMBASE/ Ovid database. We used Mantel-Haenszel method with fixed-effect model to compute risk ratio (RR) with 95% confidence interval (CI). We also performed subgroup and trial sequential analysis on the data. Results: Antibiotic envelope reduced the risk of both all infections [RR: 0.41, CI: 0.31-0.54, P < .05, I 2 = 75%, χ 2 P < .05] and major infections [RR: 0.48, CI: 0.32-0.70, P < .05, I 2 = 60%, χ 2 P = .04]. Conclusion: Prophylactic use of antibiotic envelopes as an adjuvant therapy to standard infection prevention strategies, helps in reducing the risk of CIED infections. K E Y W O R D S antibiotic envelope, cardiac implantable electronic devices R E FE R E N C E S How to cite this article: Kumar A, Doshi R, Shariff M. Role of antibiotic envelopes in preventing cardiac implantable electronic device infection: A meta-analysis of 14 859 procedures. J Arrhythmia. 2020;36:176-179. https ://doi.

The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use

“…The probability of device infection was based on the present study's derivation and standard-risk validation cohorts (n=10 237, all-comers probability of infection: 0.0081), and the estimated effect size of the AE was pooled from studies included in 3 meta-analyses (Mantel-Haenszel pooled odds ratio, 0.35 [95% CI, 0.14-0.86; I2=62%). [20][21][22] Model branches were mutually exclusive, and while the initial probability of CIED infection was calculated from the present study cohort, to promote model generalizability all subsequent probabilities were imputed from consensus in the literature (eg, probability of death if CIED infection managed without extraction, 0.422). 10,[23][24][25][26][27][28] Probability inputs are provided in the Supplemental Material.…”

Physician antibiotic hydration preferences for biologic antibacterial envelopes during cardiac implantable device procedures

“…Previous studies have established the efficacy of antibiotic eluting CIED envelopes for reducing infection risk, particularly in high-risk patients ( 21 , 40 – 42 ). Meta-analyses of published studies report >60% reductions in major CIED infections with these devices ( 40 – 42 ).…”

“…Previous studies have established the efficacy of antibiotic eluting CIED envelopes for reducing infection risk, particularly in high-risk patients ( 21 , 40 – 42 ). Meta-analyses of published studies report >60% reductions in major CIED infections with these devices ( 40 – 42 ). Options for antibiotic envelopes include the previously described non-biologic envelope impregnated with rifampin and minocycline or hydration of the biologic CanGaroo Envelope in saline containing one or more antibiotics.…”

Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis

“…Recommendation for an antibacterial mesh envelope (TYRX™, Medtronic, MN, USA) shown to significantly reduce major CIED infections in high-risk patients (WRAP-IT trial), 74 , 75 and be cost-effective 76 is discussed in more detail below ( Tables 1 and 2 ). 20 …”