A meta-analysis of antibacterial envelope use in prevention of cardiovascular implantable electronic device infection

Abstract

Objectives: Cardiac implantable electronic device (CIED) infection has been a major clinical problem in addition to being a major financial burden. In spite of antimicrobial prophylaxis, CIED infection rates have been increasing disproportionately. We therefore conducted this meta-analysis to assess the role of TYRX antibiotic envelope for the prevention of CIED infection. Methods: Using extensive online search, we conducted a meta-analysis of studies reporting CIED infections with versus without the use of TYRX antibiotic envelope. A random-effect model was used, and between studies heterogeneity was estimated with I 2. All analyses were performed with RevMan (version 5.0.20). Results: Five cohort studies were included in this meta-analysis. The pooled odds ratio (OR) of included studies was 0.29 [95% confidence interval (CI): 0.09-0.94; p < 0.004]. There was evidence of heterogeneity with I 2 of 58%. There was also evidence of publication bias on funnel plot analysis. On sensitivity analysis, no statistically significant difference was noted when stratified by study design or duration of follow-up. Conclusion: The results of our study demonstrate a significant beneficial effect of TYRX antibiotic envelope for the prevention of CIED infections.

Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer

“…Strategies to minimize the risk of CDIs include local antisepsis during implantation or the use of commercially available antibacterial envelopes (TYRX Absorbable Antibacterial Envelope, Medtronic Inc., Mounds View, MN, USA), the latter of which have been demonstrated to reduce the CDI rate in multiple studies. 6,[22][23][24][25][26][27] Two recent contributions to the literature now provide a consensus on the prevention of infections in CIED patients, as well as a survey of different practice across the world. 28,29 One large randomized controlled trial (PADIT) 30 was recently completed comparing the standard pre-operative systemic IV antibiotic dosing regimen to an incremental systemic antibiotic dosing regimen that included an additional pre-operative IV antibiotic, a perioperative antibiotic pocket wash, and post-operative antibiotics.…”

Local Vancomycin Effectively Reduces Surgical Site Infection at Implant Site in Rodents

“…Although local application of vancomycin was the technique used in our study, other options for local antibiotic delivery, such as a mesh pouch impregnated with antibiotic and designed to hold an implantable stimulator in place, should also be considered. 26 The present preclinical study suggests that there is a scientific rationale for local antibiotic treatment during implant surgery. Because the standard of care is to use systemic antibiotics presurgery, if local antibiotic could be added to the protocol it could help prevent SSI.…”

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

“…The efficacy of antibiotic envelope in preventing CIED related infection was established in the present meta‐analysis which included 14 859 procedures, substantially expanding on the previous meta‐analysis which included 4779 procedures …”