Prevention of Cardiac Implantable Electronic Device Infections: Update and Evaluation of the Potential Role for Capsulectomy or the Antibiotic Pouch

Gleva, Marye J.; Poole, Jeanne E.

doi:10.4022/jafib.1540

Cited by 13 publications

(14 citation statements)

References 34 publications

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“…It is worth noting that evidence does not definitively support their efficacy for the prevention of CIED infections [ 12 ]. Similarly, there is currently no evidence to support the use of postoperative antibiotics [ 8 ]. However, despite the minimal evidence, these strategies are common in clinical practice.…”

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future

Kong¹,

Catanzaro²,

Elayi³

et al. 2021

Cureus

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Objective: Cardiac-implantable electronic device (CIED) infections are associated with significant morbidity and mortality. In this review, we describe the risk factors and pathogenesis of CIED infections and review the rationale and the evidence for the use of antibiotic-eluting envelopes (ABEs) in patients at increased risk for CIED infections. Findings: The majority of CIED infections are caused by staphylococci that involve generator pocket and occur due to contamination of the device or the pocket tissues at the time of implantation. Clinical trials have shown that extending the duration of post-operative systemic antibacterial therapy is not beneficial in reducing CIED infection rate. However, ABEs that reduce device migration after implantation and provide sustained local delivery of prophylactic antibiotics at the pocket site, may provide benefit in reducing infection. Currently, there are two types of commercially available CIED envelope devices in the United States. The first ABE device (TYRX™, Medtronic Inc., Monmouth Junction, NJ) is composed of a synthetic absorbable mesh envelope that elutes minocycline and rifampin and has been shown to reduce CIED pocket infections in a large multi-center randomized clinical trial. The second ABE device (CanGaroo-G™, Aziyo Biologics, Silver Spring, MD) is composed of decellularized extracellular matrix (ECM) and was originally designed to stabilize the device within the pocket, limiting risk for migration or erosion, and providing a substrate for tissue ingrowth in a preclinical study. This device has shown promising results in a preclinical study with local delivery of gentamicin. Compared with artificial materials, such as synthetic surgical mesh, biologic ECM has been shown to foster greater tissue integration and vascular ingrowth, a reduced inflammatory response, and more rapid clearance of bacteria. Conclusions and Relevance: ABE devices provide sustained local delivery of antibiotics at the generator pocket site and appear beneficial in reducing CIED pocket infections. Given the continued increase in the use of CIED therapy and resultant infectious complications, innovative approaches to infection prevention are critical.

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Section: Reviewmentioning

confidence: 99%

“…Both agents are active against Staphylococcus spp. [ 8 ]. The reported MIC of rifampin for S. aureus and coagulase-negative Staphylococci isolated from CIED infections is ~0.5 to 2 mg/L [ 39 ].…”

Section: Reviewmentioning

confidence: 99%

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future

Kong¹,

Catanzaro²,

Elayi³

et al. 2021

Cureus

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show abstract

“…TYRX™ is coated with two antibiotics with different mechanisms of action, but both with activity against staphylococci . The bioabsorbable envelope releases these antibiotics over time and is fully resorbed around 9 weeks postprocedure …”

Section: Discussionmentioning

confidence: 92%

Use of antibiotic envelopes to prevent cardiac implantable electronic device infections: A meta‐analysis

Koerber

Turagam

Winterfield

et al. 2018

Cardiovasc electrophysiol

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“…Cardiac pacemaker IPG exchange studies have shown that total scar capsulotomy is associated with increased rates of postoperative hematoma and with no difference in postoperative infection rates. 2,3 However, removal of the scar capsule is thought to promote local inflammatory reaction and scarring, which may reduce the risk of seroma and IPG migration. Therefore, a limited capsulotomy is thought to balance reducing seroma and migration with the risk of hematoma.…”

Section: Discussionmentioning

confidence: 99%

Hypoglossal Nerve Stimulator Implantable Pulse Generator Exchange for Battery Depletion

Goates

Louis

Olson

2020

Otolaryngol.--head neck surg.

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Prevention of Cardiac Implantable Electronic Device Infections: Update and Evaluation of the Potential Role for Capsulectomy or the Antibiotic Pouch

Cited by 13 publications

References 34 publications

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future

Use of antibiotic envelopes to prevent cardiac implantable electronic device infections: A meta‐analysis

Hypoglossal Nerve Stimulator Implantable Pulse Generator Exchange for Battery Depletion

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