抗菌药物囊袋冲洗预防起搏器囊袋感染的效果：一项荟萃分析。
Effect of pocket irrigation with antimicrobial on prevention of pacemaker pocket infection: a meta-analysis.
作者信息
Kang Feng-Guang, Liu Pei-Jian, Liang Li-Yi, Lin Yong-Qing, Xie Shuang-Lun, He Yi, Liang Bao-Shan, Zhang Hai-Feng, Chen Yang-Xin, Wang Jing-Feng
机构信息
ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, Guangdong, 528333, People's Republic of China.
Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
出版信息
BMC Cardiovasc Disord. 2017 Sep 30;17(1):256. doi: 10.1186/s12872-017-0689-9.
BACKGROUND
The presence of cardiac implantable electronic devices (CIEDs) pocket infection is difficult to treat, causing serious clinical outcomes, but little is known for prevention. Results from some studies suggested that pocket irrigation could reduce infection while others showed conflicting results. We pooled the effects of pocket irrigations on the prevention of pocket infection by meta-analysis methods.
METHOD
Relevant studies published before June, 2017 were retrieved mainly by the computer-based search of PubMed, Cochrane, EMBASE, Web of Science, Chinese BioMedical, Global Health and BIOSIS Previews databases. Estimations of relative ratios (RRs) and 95% confidence intervals (95% CIs) were pooled. Subgroup analyses according to potential key factors affecting the effects were conducted, which was confirmed by meta-regression. Sensitivity analysis and test for publication bias were also performed.
RESULTS
We identified 10 studies providing data of 5467 patients receiving CIEDs implantations. Pooled infection rates were 1.48 and 3.49% respectively for medication and saline irrigation groups. Meta-analysis showed that medication irrigation conferred protection to pocket infection (RR = 0.44, 95% CI: 0.31-0.63). Subgroup analysis showed that antibiotics, rather than non-antibiotics (antiseptics) exerting the protection. The first and second lines antibiotics against staphylococcus aureus, which is the main pathogen for pocket infection, were both effective (RR = 0.42, 95% CI: 0.24-0.75 and RR = 0.34, 95% CI: 0.20-0.58 respectively for first line and second line therapies). Meta-regression revealed that region and class of irrigation medication completely explained the variance among studies and implied that effects of region were masked by medication types. Sensitivity analysis did not showed any significant change of the result and publication bias were not statistical significance.
CONCLUSION
Pocket irrigation with antibiotics were effective for reducing pocket infection and should be encouraged in CIEDs implantation.
背景
心脏植入式电子设备（CIED）囊袋感染难以治疗，会导致严重的临床后果，但对于其预防措施知之甚少。一些研究结果表明囊袋冲洗可减少感染，而其他研究则显示出相互矛盾的结果。我们采用荟萃分析方法汇总囊袋冲洗对预防囊袋感染的效果。
方法
主要通过基于计算机检索PubMed、Cochrane、EMBASE、科学网、中国生物医学数据库、全球健康数据库和生物学文摘数据库，检索2017年6月之前发表的相关研究。汇总相对比值（RRs）和95%置信区间（95% CIs）的估计值。根据影响效果的潜在关键因素进行亚组分析，并通过荟萃回归进行确认。还进行了敏感性分析和发表偏倚检验。
结果
我们确定了10项研究，提供了5467例接受CIED植入患者的数据。药物冲洗组和生理盐水冲洗组的汇总感染率分别为1.48%和3.49%。荟萃分析表明，药物冲洗可预防囊袋感染（RR = 0.44，95% CI：0.31 - 0.63）。亚组分析表明，发挥预防作用的是抗生素，而非非抗生素（防腐剂）。针对囊袋感染主要病原体金黄色葡萄球菌的一线和二线抗生素均有效（一线和二线治疗的RR分别为0.42，95% CI：0.24 - 0.75和RR = 0.34，95% CI：0.20 - 0.58）。荟萃回归显示，冲洗药物的区域和类别完全解释了各研究之间的差异，并表明区域效应被药物类型所掩盖。敏感性分析未显示结果有任何显著变化，发表偏倚无统计学意义。
结论
抗生素囊袋冲洗对减少囊袋感染有效，在CIED植入中应予以鼓励。
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