Efficacy of antimicrobial envelopes in preventing cardiac implantable electronic device infection - systematic review and meta-analysis

Cardiac implantable electronic device (CIED) procedures have become increasingly common, accompanied by the challenge of CIED infections. This review aims to synthesise the available evidence to evaluate the efficacy of antibiotic eluting envelopes (AEEs) in preventing CIED infections and its effects on mortality. All randomised controlled trials and observational studies that evaluated the efficacy of AEE use in reducing risk of CIED infections were included. Use of the TYRX AEE and CanGaroo envelopes hydrated in antibiotic solutions were considered for inclusion. The initial search yielded 493 articles, with 14 studies relevant for inclusion. A total of 87184 patients were included, with 14650 patients who received an AEE and 72534 patients who did not. AEE use did not result in a statistically significant reduction in the odds of any CIED infection over total study duration (OR 0.73, 95% CI: 0.49-1.08), or within 12 months following CIED implantation (OR 0.85, 95% CI: 0.62-1.18). There was no reduction in odds of major CIED infection over total study duration (OR 0.73, 95% CI: 0.44-1.22) or within 12 months (OR 0.79, 95% CI: 0.46-1.37). The odds of minor CIED infection over any time (OR 0.75, 95% CI: 0.48-1.18) and overall mortality (OR 1.07, 95% CI: 0.60-1.88) were also not reduced. However, subgroup analysis for patients at high risk of infection found that AEE use was associated with a reduction in total CIED infections over total study duration (OR 0.66, 95% CI: 0.45-0.97) and within 12 months (OR 0.73, 95% CI: 0.56-0.95).