Infections. It’s one thing to avoid bacteria from getting into an open wound, but it’s a whole different battle when dealing with cardiac implantable electronic devices (CIED). Out of 1.7 million patients, 1 to 4% of patients end up with a form of infection. Infections after the placement of CIEDs are associated with substantial morbidity and mortality, and while there are antibiotic methods to lower the risk of infection, there is limited evidence on prophylactic strategies. In fact, currently the only proven prevention is giving a dose of intravenous antibiotics at the time of the procedure.
That is, until now.
A new article published on the New England Journal of Medicine assess the results of a trial, showing a 40% reduction in major infections and a 61% reduction of pocket infections when utilizing a specially developed envelope to house CIEDs. “The envelope worked,” said UW Cardiologist and co-principal investigator Jeanne Poole, MD.
The article details the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial (WRAP-IT), with results showing a significantly lower incidence of major CIED infections when using an absorbable, antibiotic-eluting envelope to house the implants. Normally, if a patient were to develop an infection after the implementation of the device, a procedure would be needed to extract the device, which then puts the patient at risk of tearing the heart, according to Dr. Poole. By placing the device within the specialized envelope, these results that infection rates can be lowered in the types of patients included in this study.
An additional feat of the trial was how the additional steps of WRAP-IT had no increase in the procedure time or complication risk, with a success rate of 99.7% for the procedures.
We’d like to congratulate Dr. Poole and the WRAP IT investigator team for her contributions to the trial, and are excited for the new possibilities this brings for patients all around the world.