Introduction: There have been a number of advances in cardiac implantable device (CIED) implantation techniques which have reduced the number of device related infections. The risk of infection, however, still has significant impact on hospitalisation and mortality (Koerber SM et al., 2018). The adjunctive use of the Medtronic TYRXTM antibacterial envelope has been shown to significantly reduce device infection rates (Tarakji K et al., 2019). We looked at the rate of infection for all device re-intervention procedures over a 3-year period prior to the use of TYRXTM and compared this to re-intervention procedures performed after the introduction of TYRXTM in our centre.
Methods: We conducted a retrospective study of consecutive device re-intervention procedures between 2015 and 2017 prior to the use of TYRXTM. Information regarding infection was taken from electronic patient records.
Results: There were a total of 47 patients who underwent device
re-intervention procedures between 2015 and 2017. Of these 47 patients, four patients were excluded due to follow up being transferred to another centre post implant and one was excluded due to insufficient information on electronic patient records. In the re-intervention group, there were 15 consecutive patients who received a TYRXTM between June 2017–June 2018. No patients were excluded in the TYRXTM group. There was no significant difference in demographics between the two groups. In the non-TRYXTM group, 28 patients received re-intervention for a single lead repositioning, four patients underwent double lead repositioning in a single procedure and 10 patients underwent re-intervention for device repositioning. Over a 3-year period, three patients experienced a device related infection post re-intervention (7.14%). All three infections occurred in 2017. In the TYRX group, 10 patients underwent re-intervention for single lead repositioning, of these patients, seven underwent the re-intervention within two days of the initial procedure. Two patients underwent a system upgrade, two patients had a device re-burial and one patient had a routine generator change however was considered high-risk of infection therefore received a TYRX. The infection rate in the TYRX group remains 0% from June 2018 to May 2019. The results demonstrate that the use of TYRX as an adjunctive therapy to routine antibiotics can reduce rates of infection.
Discussion: In the UK, it is estimated that cardiac implantable device (CIED) infections cost the NHS an average of £30,9582 (Ahsan S et al., 2014). Early re-intervention, renal failure/insufficiency, dialysis dependency, type of device implanted, procedure type, use of corticosteroids and oral anticoagulants all present a higher risk for infection. Despite proper management of CIED infection, morbidity and mortality short-term and long-term remain high (Baman T et al., 2009). Up until now, there have been a number of single-centre, non-randomised studies which have shown that the use of the TYRXTM antibacterial envelope reduces infection (Bloom H et al., 2011). The WRAP-IT study is the first randomised, controlled trial which has demonstrated a significant reduction in major CIED infections regardless of type of intervention. A disadvantage of the envelope is currently the cost and short shelf-life however with appropriate patient selection, this cost can be considered unsubstantial compared to the cost of treating CIED related infections.