title: Use of an antibacterial envelope is associated with reduced cardiac implantable electronic device infections in high-risk patients.
abstract: BACKGROUND
  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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kolek
authors.forename: William F
authors.initials: WF
authors.lastname: Dresen
authors.forename: Quinn S
authors.initials: QS
authors.lastname: Wells
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ellis
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents