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20 March, 2019 00:00 00 AM
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‘Antibiotic envelopes’ could cut infections after pacemaker implant

‘Antibiotic envelopes’ 
could cut infections 
after pacemaker implant

Tucking a pacemaker inside an antibiotic-soaked mesh envelope before implanting it inside your body can drastically reduce your risk of a dangerous infection, a new study shows. About 1.7 million patients receive cardiac implants like pacemakers or defibrillators every year worldwide, and doctors use preoperative antibiotics to lower the chances of infection.

Nonetheless, about 1.2 per cent of these patients will develop a potentially grave infection that's costly to treat, said lead researcher Dr. Khaldoun Tarakji. He's associate section head of cardiac electrophysiology at the Cleveland Clinic. But a new clinical trial found that if the cardiac devices are implanted inside a mesh envelope that time-releases antibiotics, the risk of infection for that unlucky minority of patients is cut by 40 per cent, Tarakji said.

"It's basically a mesh that's embedded with two antibiotics, minocycline and rifampin," Tarakji said. "They release in the pocket within the first seven days after the implantation. The envelope itself dissolves in nine weeks, so there won't be anything left from the mesh itself." The TYRX Absorbable Antibacterial Envelope has already been approved by the US Food and Drug Administration, but this appears to be the first randomised, controlled clinical trial conducted on its use in heart implants, said Dr. Davendra Mehta, a cardiac electrophysiologist at Mount Sinai St. Luke's and a professor of cardiology at the Icahn School of Medicine at Mount Sinai, in New York City.

"That's really good information, and clearly shows that using the antibacterial envelope decreased infections," Mehta said.

The trial results were to be presented Sunday at the American College of Cardiology's annual meeting in New Orleans. The report will be simultaneously published in the New England Journal of Medicine. The study was funded by Medtronic, the manufacturer of the envelope. The trial involved nearly 7,000 patients at 181 hospitals in 25 countries, all of whom were scheduled to undergo procedures involving their cardiac devices. The patients all received standard antibiotics prior to their operation, and then half were chosen at random to also have their device inserted into an antibiotic envelope.

About 1.2 per cent of patients in the "control" group developed a major infection, compared with 0.7 per cent of patients in the "envelope" group, the researchers found. Of the major infections, 17 involved endocarditis, a potentially life-threatening infection of the heart's inner lining. Another 50 infections involved the chest "pocket" into which the devices are implanted, and were less serious.

The TYRX envelopes cost between $1,000 to $2,000, Medtronic said.  Patients who have a high risk of infection will likely benefit most from these envelopes, Mehta said. These include patients with diabetes or heart failure, those whose immune systems are compromised by disease or treatment, people with HIV, or folks with a prior history of device infection.

"The envelope totally dissolves. It doesn't leave any scarring or anything like that," Mehta said. "My only concern is the added cost, for the number of procedures you would have to do to prevent one infection."

Cost-benefit data were gathered during the trial and an analysis is upcoming, Tarakji said.

But both Tarakji and Mehta noted that removing a device because of an infection tends to be a very costly proposition.

 HealthDay

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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