Use of an Antibacterial Envelope is Associated with Reduced Cardiac Implantable Electronic Device Infections in High-Risk Patients

Authors

  • MATTHEW J. KOLEK M.D.,

    1. Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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  • WILLIAM F. DRESEN M.D.,

    1. Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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  • QUINN S. WELLS M.D.,

    1. Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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  • CHRISTOPHER R. ELLIS M.D.

    Corresponding author
    • Cardiovascular Medicine Division, Department of Internal Medicine, Cardiac Electrophysiology Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
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  • Disclosures: C.R. Ellis: Research funding/speakers bureau, Boehringer-Ingelheim Pharmaceuticals (significant); Honorarium/speakers fees, TyRX Inc.; Fellows education/honorarium, Boston Scientific. For other authors: none. This study received no external research funding. It was C.R. Ellis's own project and time invested.

Address for reprints: Christopher R. Ellis, M.D., Department of Internal Medicine, Cardiovascular Medicine Division, Cardiac Electrophysiology Section, Vanderbilt Heart and Vascular Institute, 5414 Medical Center East, Nashville, TN 37232-8802. Fax: 615-936-5064; e-mail: Christopher.ellis@vanderbilt.edu

Abstract

Introduction

The incidence of cardiac implantable electronic device (CIED) infections has risen rapidly since 2004. A commercially available minocycline and rifampin impregnated antibacterial envelope has been associated with a low CIED infection rate. We performed a retrospective cohort study analyzing CIED infection rates in patients receiving an antibacterial envelope.

Methods

Prospectively applied criteria for use of the antibacterial envelope included ≥2 of the following: diabetes, renal insufficiency, anticoagulation, chronic corticosteroid use, fever or leukocytosis at the time of implantation, prior CIED infection, ≥3 leads (cardiac resynchronization therapy or abandoned leads), pacemaker dependence, or early pocket reentry. CIED infection rate was compared to a cohort of patients with matched risk factors and a CIED implanted prior to use of the antibacterial envelope.

Results

A total of 260 antibacterial envelopes were implanted from November 1, 2009 to April 30, 2012. The mean number of CIED infection risk factors was 2.8 ± 1.2. The control cohort (N = 639) was matched for mean number of CIED infection risk factors (2.8 ± 1.2), though individual risk factors differed. After a minimum of 90 days of follow-up, there was one CIED infection among patients who received an antibacterial envelope (0.4%), compared to 19 (3%) in controls (odds ratio [95% confidence interval] 0.13 [0.02–0.95], P = 0.04). This difference persisted after adjustment for covariates (0.09 [0.01–0.73], P = 0.02) and propensity score matching (0.11 [0.01–0.85], P = 0.04).

Conclusions

In patients prospectively identified at high risk for CIED infection, use of a commercially available antibacterial envelope was associated with a marked reduction in CIED infections when compared to a matched control cohort.

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