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

BMC Cardiovascular Disorders

Research Article

Yong-Qing Lin¹  Shuang-Lun Xie¹  Hai-Feng Zhang¹  Jing-Feng Wang¹  Yang-Xin Chen¹  Pei-Jian Liu²  Li-Yi Liang²  Yi He²  Feng-Guang Kang²  Bao-Shan Liang² 

[1] Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, Guangdong, People’s Republic of China;Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, 510120, Guangzhou, Guangdong, People’s Republic of China;ShunDe Hospital of Guangzhou University of Chinese Medicine, 528333, Foshan, Guangdong, People’s Republic of China;

关键词: Cardiac implantable electronic devices;    Pocket irrigation;    Pocket Infection;    Meta-analysis;   

DOI  :  10.1186/s12872-017-0689-9

 received in 2017-06-24, accepted in 2017-09-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodRelevant 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.ResultsWe 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.ConclusionPocket irrigation with antibiotics were effective for reducing pocket infection and should be encouraged in CIEDs implantation.

【 授权许可】

CC BY   
© The Author(s). 2017