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Meta-Analysis
. 2017 Sep 30;17(1):256.
doi: 10.1186/s12872-017-0689-9.

Effect of pocket irrigation with antimicrobial on prevention of pacemaker pocket infection: a meta-analysis

Feng-Guang Kang  1 , Pei-Jian Liu  1 , Li-Yi Liang  1 , Yong-Qing Lin  2   3 , Shuang-Lun Xie  2   3 , Yi He  1 , Bao-Shan Liang  1 , Hai-Feng Zhang  4   5 , Yang-Xin Chen  6   7 , Jing-Feng Wang  8   9
Affiliations
Meta-Analysis

Effect of pocket irrigation with antimicrobial on prevention of pacemaker pocket infection: a meta-analysis

Feng-Guang Kang et al. BMC Cardiovasc Disord. .

Abstract

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.

Keywords: Cardiac implantable electronic devices; Meta-analysis; Pocket Infection; Pocket irrigation.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Systematic search and screening process of included trials
Fig. 2
Fig. 2
Quality assessments of included studies
Fig. 3
Fig. 3
Meta-analysis of all the included studies on protective effects conferred by pocket irrigation. Estimated effect size was derived by Mantel-Haenszel fixed-effects model and heterogeneity test P-value was calculated by Cochrane Q-test. Size of the box represented weight of the study on the over-all results
Fig. 4
Fig. 4
Subgroup analyses according to region (a), irrigation medications (b), study design (c), and first/second line therapy for staphylococcus aureus (d) and early/late infection (e). Methods used and meaning of symbols were the same as Fig. 3
Fig. 5
Fig. 5
Meta-regression using interaction between region and class of medication (antibiotics/non-antibiotics) used for irrigation. The interaction explained almost all of the variance among enrolled studies. Meta-analysis was performed using restricted maximum likelihood estimation. Size of the box represented study weight. Symbols represents indicated RRs and 95% CIs of the study and dotted line indicated the American study. Orange symbols indicated study using non-antibiotics (povidone-iodine). Gray shading area represented 95% CIs of the regression line
Fig. 6
Fig. 6
Publication bias of included studies. P-value was derived by Egger’s test. Size of the circle indicated study weight
See this image and copyright information in PMC

References

    1. de Oliveira JC, Martinelli M, Nishioka SA, Varejão T, Uipe D, Pedrosa AA, et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol. 2009;2(1):29–34. doi: 10.1161/CIRCEP.108.795906. - DOI - PubMed
    1. Tarakji KG, Wilkoff BL. Management of cardiac implantable electronic device infections: the challenges of understanding the scope of the problem and its associated mortality. Expert Rev Cardiovasc Ther. 2013;11(5):607–616. doi: 10.1586/erc.12.190. - DOI - PubMed
    1. Cabell CH, Heidenreich PA, Chu VH, Moore CM, Stryjewski ME, Corey GR, et al. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999. Am Heart J. 2004;147(4):582–586. doi: 10.1016/j.ahj.2003.06.005. - DOI - PubMed
    1. Schwartzman D, Pasculle AW, Ceceris KD, Smith JD, Weiss LE, Campbell PG. An off-the-shelf plasma-based material to prevent pacemaker pocket infection. Biomaterials. 2015;60:1–8. doi: 10.1016/j.biomaterials.2015.04.042. - DOI - PubMed
    1. Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med. 2012;367(9):842–849. doi: 10.1056/NEJMcp1107675. - DOI - PubMed

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