Antibiotic envelope is associated with reduction in cardiac implantable electronic devices infections especially for high‐power device—Systematic review and meta‐analysis

Background 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. Methods We performed a comprehensive search on topics that assesses antibiotic envelope and implantable cardiac electronic device up until August 2019. Results 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], P = .04; I 2 : 58% and HR 0.52 [0.32, 0.85], P = .009; I 2 : 80%. Upon sensitivity analysis by removing a study, the OR became 0.40 [0.27, 0.59], P < .001; I 2 : 46%. Subgroup analysis for 12 months’ infection was OR 0.65 [0.43, 0.99], P = .04; I 2 : 49%. Meta‐analysis of propensity‐matched cohort showed a reduced risk of infection with AE (OR of 0.14 [0.05, 0.41], P < .001; I 2 :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], P = .001; I 2 :0%) but not low‐power device. Conclusion 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.