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Effect of pocket irrigation with antimicrobial on prevention of pacemaker pocket infection: a meta-analysis
Feng-Guang Kang1, Pei-Jian Liu1, Li-Yi Liang1
1ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, Guangdong, 528333, People's Republic of China.
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.
Insights
Antibiotic pocket irrigation significantly reduces cardiac implantable electronic device (CIED) infections. This meta-analysis confirms that using antibiotics, not antiseptics, during CIED implantation prevents pocket infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Cardiac implantable electronic device (CIED) pocket infections pose significant clinical challenges.
- Prevention strategies, such as pocket irrigation, have shown conflicting results.
- Limited data exists on effective methods to prevent CIED pocket infections.
Purpose of the Study:
- To evaluate the efficacy of pocket irrigation in preventing CIED pocket infections.
- To compare the effectiveness of different irrigation solutions, including antibiotics and saline.
- To identify factors influencing the success of pocket irrigation in infection prevention.
Main Methods:
- A meta-analysis was conducted on 10 studies involving 5467 patients undergoing CIED implantation.
- Studies published before June 2017 were systematically searched across multiple databases.
- Pooled infection rates and relative ratios (RRs) with 95% confidence intervals (CIs) were calculated.
Main Results:
- Medication irrigation significantly reduced pocket infection rates compared to saline irrigation (RR = 0.44, 95% CI: 0.31-0.63).
- Antibiotic irrigation, specifically first and second-line antibiotics against Staphylococcus aureus, demonstrated protective effects.
- Meta-regression indicated that the type of irrigation medication, rather than region, explained study variances.
Conclusions:
- Pocket irrigation with antibiotics is an effective strategy for preventing CIED pocket infections.
- Antibiotic irrigation should be recommended during CIED implantation procedures.
- Further research may focus on specific antibiotic classes and regional variations.
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