Meta Analysis Of The Efficacy Of Antibacterial Envelope In The Prevention For Cardiovascular Implantable Electronic Device Infection

Background and objective:Cardiovascular implantable electronic device(CIED)is an important equipment in arrhythmia therapy,especially in bradyarrhythmia.Along with the increasing of number of CIED implantation and the chance of repeated operation,the type of the device and the operation method become more complicated,then the CIED infection has been becoming a more and more prominent issue.Although related guide and consensus to CIED infection has been formulated,CIED infection still plagued the medical staff and patients,as disgustful as the "demon".The growth rate of infection was higher than that of CIED implantation in recent years.Prepare for a rainy day,We should focus on prevention.The preventive use of antibiotics is a very important part of the prevention.Aigis Rx antibacterial envelope is impregnated with antibiotics polypropylene mesh,which can release of minocycline and Li Fuping to prevent infection.Now some studies showed that antibacterial envelope could prevent CIED infection,but the results were not consistent.We take advantage of the knowledge of evidence-based medicine,retrieving recently published trials about antibacterial envelope on prevention for cardiovascular implantable electronic device infections,to discuss the effect of antibacterial envelope.Methods:Comprehensive search including PubMed,MEDLINE,Elsevier,Cochrane library,EMBASE foreign language database contains all the clinical trials of antibacterial envelope,the search time is set to build the database to March 2017.The quality evaluation and data extraction were carried out independently by 2 people.According to the type of study,the Oxford scoring system(Jadad score)or Newcastle-Ottawa Scale(NOS)literature quality evaluation scale was selected.According to the results of heterogeneity test,the fixed or random effect model was selected.The data cited in the literature were selected using Review Manager 5.3 for statistical analysis.Results:Six trials with a total of 5254 patients were identified.Men accounted for 52.6%.Inclusion criteria patients who were included in the studies should have at least 2 of risk factors,such as diabetes,renal insufficiency,prior CIED infection,chronic anti-coagulation or corticosteroid use,≥3 leads,early pocket reentry and so on.All patients received standard peri-operative doses of systemic antibiotics.The data analysis shows that the use of antibacterial network group has lower infection rate than in the control group(0.88% VS 2.3%),but the difference was not statistically significant(RR=0.36,95%CI[0.11-1.19],P=0.09).Chi square test shows that the heterogeneity is large,I2=66%,so we use random effects model for data analysis.The rate of infection related equipment removal in antibacterial network group is low than control group(RR=0.32,95%CI[0.14-0.74],P=0.008),and all-cause mortality is also low than the control group(RR=0.48,95%CI[0.24-0.96],P=0.04),then both differences were statistically significant.Infection related mortality is low than the control group,but the difference was not statistically significant(RR=0.93,95%CI [0.22-3.96],P=0.92).Conclusion:1.Antibacterial envelope can reduce the rate of all-cause mortality and infection related equipment removal rate in patients who implant cardiovascular implantable electronic device with high risk of infection.2.Antibacterial envelope can reduce the infection rate of cardiovascular implantable electronic device,but there was no statistical significance.