Asbeutah Abdul Aziz A, Salem Majed H, Asbeutah Saad A, Abu-Assi Mona A
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Medicine (Baltimore). 2020 Jun 26;99(26):e20834. doi: 10.1097/MD.0000000000020834.
Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems.
To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A random-effects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI).
We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72).
The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection.
在过去十年中，心脏植入式电子设备（CIED）相关感染的发生率有所上升，并与发病率、死亡率增加以及医疗系统的经济负担加重相关。
为了研究抗菌封套在减少主要CIED相关感染方面的效果，我们进行了一项系统评价和荟萃分析，通过检索PubMed/MEDLINE、CENTRAL、谷歌学术和Clinicaltrials.gov，查找截至2020年2月15日研究抗生素封套在减少主要CIED相关感染（包括与设备相关的心内膜炎、需要全身使用抗生素和/或取出设备的全身感染）方面效果的研究，并与对照组进行比较。通过计算风险比（RR）和各自的95%置信区间（CI）进行随机效应荟萃分析。
我们纳入了6项研究，共11897例患者，其中5844例接受了抗生素封套，6053例未接受。与对照组相比，在手术时使用抗生素封套与感染高危患者中主要CIED相关感染的相对风险显著降低74%相关（RR：0.26 [95%CI，0.08 - 0.85]；P = 0.03），而在来自任何感染风险研究的患者中未观察到显著降低（RR：0.53 [95%CI，0.06 - 4.52]；P = 0.56）。此外，与对照组相比，接受封套的患者死亡率没有降低（RR：1.15 [95%CI，0.53 - 2.50]；P = 0.72）。
在设备植入或升级时使用抗生素封套可减少主要CIED感染，特别是在被认为感染风险较高的患者中使用时。
