Key result
Pocket irrigation with antimicrobial solutions reduced the rate of cardiac implantable electronic device pocket infection compared to control.
Why the study?
Does pocket irrigation with antimicrobial medications reduce pocket infection in patients receiving CIEDs implantations?
Meta-Analysis (n=5,467)
Does pocket irrigation with antimicrobial medications reduce pocket infection in patients receiving CIEDs implantations?
Pocket irrigation with antibiotics significantly reduces the incidence of CIED pocket infections and should be encouraged during implantation procedures.
Answers are grounded in this paper and cite their sources.
May support antimicrobial irrigation to reduce CIED pocket infections; leaves open need for RCTs to confirm.
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.
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Kang et al. (2017) conducted a meta-analysis in Cardiac implantable electronic device (CIED) pocket infection (n=5,467). Pocket irrigation with antimicrobial solutions vs. Saline irrigation or no medication was evaluated on Pocket infection (RR 0.44, 95% CI 0.31-0.63). Pocket irrigation with antimicrobial solutions reduced the rate of cardiac implantable electronic device pocket infection compared to control.
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