Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta‐analysis

Introduction: Several studies have shown inconsistent relationship between post-implantation hematoma (PH) and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of PH and the risk of CIED infection. Hypothesis: PH increases the risk of CIED infection. Methods: We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies and randomized controlled trials that reported incidence of PH and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Fourteen studies from 2006 to 2018 were included, involving a total of 28,319 participants. There were 6 cohort studies, 7 case-control studies and 1 randomized controlled trial. In random-effect model, we found that PH significantly increases the risk of overall CIED infection (OR = 6.30, 95%CI: 3.87-10.24, I2=49.3%) (Figure 1). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: Our meta-analysis demonstrated that PH significantly increases the risk of CIED infection. Precaution should be taken to during device implantation to reduce PH and subsequent CIED infection.

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

Journal of Arrhythmia ◽

10.1002/joa3.12302 ◽

2020 ◽

Vol 36 (2) ◽

pp. 377-377 ◽

Cited By ~ 1

Author(s):

Abdul Aziz A. Asbeutah

Keyword(s):

Electronic Device ◽

Meta Analysis ◽

Cardiac Implantable Electronic Device ◽

Device Infection

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Abstract 103: A Meta Analysis of Antibiotic Envelope Use to Prevent Cardiac Implantable Electronic Device Infections

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.103 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Muhammad U Khan ◽

Ahmad Naeem Lone ◽

Muhammad Khan ◽

shahul valavoor ◽

Muhammad Munir ◽

...

Keyword(s):

Infection Prevention ◽

Electronic Device ◽

Meta Analysis ◽

Electronic Devices ◽

Control Group ◽

Preventive Strategy ◽

Cardiac Implantable Electronic Device ◽

Cardiac Implantable Electronic Devices ◽

Device Infection ◽

Effective Preventive Strategy

Introduction: Cardiac Implantable Electronic Device (CIED) infections are a major source of morbidity, mortality and increased healthcare cost. There are several well established risk factors associated with increased infection. An antibiotic coated envelope has been developed as an infection prevention intervention. Hypothesis: Whether antibiotic coated envelope is an effective preventive strategy against Cardiac Implantable Electronic Device Infections. Methods: 6 trials comparing use of antibiotic envelope to control, including 1 randomized trial and 5 cohort studies were selected using PubMed and Embase data bases through May 2019. The efficacy end point was prevention of CIED Infection. Outcomes were combined using random effects model and estimated by odds ratio with 95% confidence intervals (CI). Results: In our analysis of total 12,024 patients undergoing CIED implantation, 5,844 patients received antibiotic envelope while 6,180 patients were included in the control group. Antibiotic envelope was superior to control in reducing the risk of device infection (OR 0.40 CI [0.17-0.95], p=0.04). Conclusions: The use of antibiotic envelope in Cardiac Implantable Electronic Devices (CIED) is associated with reduced incidence of CIED infection.

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Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-029537 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029537 ◽

Cited By ~ 1

Author(s):

Derek Chew ◽

Ranjani Somayaji ◽

John Conly ◽

Derek Exner ◽

Elissa Rennert-May

Keyword(s):

Systematic Review ◽

Electronic Device ◽

Meta Analysis ◽

Secondary Outcome ◽

Significant Heterogeneity ◽

Inclusion Criteria ◽

Cardiac Implantable Electronic Device ◽

Initial Management ◽

Device Infection ◽

Incident Rate

ObjectivesInitial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates.DesignSystematic review and meta-analysis.InterventionsA systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate.Primary and secondary outcome measuresThe primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality.ResultsOf the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15–220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%).ConclusionsThe incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation.PROSERO registration numberCRD4201810960.

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