Pranata Raymond, Tondas Alexander Edo, Vania Rachel, Yuniadi Yoga
Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia.
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Sriwijaya Dr. Mohammad Hoesin General Hospital Palembang Indonesia.
J Arrhythm. 2019 Nov 29;36(1):166-173. doi: 10.1002/joa3.12270. eCollection 2020 Feb.
Infections after cardiac implantable electronic device (CIED) placement are associated with significant morbidity and mortality. The incidence of CIED is increasing overtime despite the optimal use of antimicrobial agents. This systematic review and meta-analysis will address the latest evidence on the use of AE to mitigate the risk of CIED infection, and which subset of patients will they benefit the most.
We performed a comprehensive search on topics that assesses antibiotic envelope and implantable cardiac electronic device up until August 2019.
There were a total of 32,329 subjects from six studies. Antibiotic envelope was associated with a lower risk of major infection with OR 0.42 [0.19, 0.97], = .04; I: 58% and HR 0.52 [0.32, 0.85], = .009; I: 80%. Upon sensitivity analysis by removing a study, the OR became 0.40 [0.27, 0.59], < .001; I: 46%. Subgroup analysis for 12 months' infection was OR 0.65 [0.43, 0.99], = .04; I: 49%. Meta-analysis of propensity-matched cohort showed a reduced risk of infection with AE (OR of 0.14 [0.05, 0.41], < .001; I:0%). Mortality was similar in both AE and control groups. Antibiotic envelope reduced the incidence of infection in patients receiving high-power device (OR 0.44 [0.27, 0.73], = .001; I:0%) but not low-power device.
Antibiotic envelope (TYRX) was found to be safe and effective in reducing the risk of major infections in high-risk patients receiving CIED implantation, especially in those receiving high-power CIED.
心脏植入式电子设备（CIED）植入后的感染与显著的发病率和死亡率相关。尽管抗菌药物得到了优化使用，但CIED的发病率仍在随时间增加。本系统评价和荟萃分析将阐述关于使用抗菌包膜（AE）降低CIED感染风险的最新证据，以及哪类患者亚组将从中获益最大。
我们对截至2019年8月评估抗生素包膜和植入式心脏电子设备的主题进行了全面检索。
六项研究共有32329名受试者。抗生素包膜与较低的主要感染风险相关，比值比（OR）为0.42[0.19，0.97]，P = 0.04；异质性（I²）为58%，风险比（HR）为0.52[0.32，0.85]，P = 0.009；I²为80%。通过剔除一项研究进行敏感性分析后，OR变为0.40[0.27，0.59]，P < 0.001；I²为46%。12个月感染的亚组分析中，OR为0.65[0.43，0.99]，P = 0.04；I²为49%。倾向匹配队列的荟萃分析显示，使用AE可降低感染风险（OR为0.14[0.05，0.41]，P < 0.001；I²为0%）。AE组和对照组的死亡率相似。抗生素包膜降低了接受高功率设备患者的感染发生率（OR为0.44[0.27，0.73]，P = 0.001；I²为0%），但对低功率设备患者无效。
发现抗生素包膜（TYRX）在降低接受CIED植入的高危患者，尤其是接受高功率CIED患者的主要感染风险方面安全有效。
