Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement

Results of the Citadel and Centurion Studies

Charles A. Henrikson, M. Rizwan Sohail, Helbert Acosta, Eric Johnson, Lawrence Rosenthal, Roman Pachulski, Dan Dan, Walter Paladino, Farhat S. Khairallah, Kent Gleed, Ibrahim Hanna, Alan Cheng, Daniel R. Lexcen, Grant R. Simons

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. Background TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. Methods We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. Results Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4%; 95% confidence interval: 0.0% to 0.9%), significantly lower than the 12-month benchmark rate of 2.2% (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7% compared with an infection rate of 1.0% and 1.3% (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2% compared with the published benchmark of 2.2% (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6%; 95% confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6%. Conclusions Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705)

Original languageEnglish (US)
Pages (from-to)1158-1167
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2017

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Cardiac Resynchronization Therapy Devices
Implantable Defibrillators
Equipment and Supplies
Infection
Benchmarking
Comorbidity
Research Design
Cardiovascular Infections
Confidence Intervals
Control Groups
Minocycline
Polypropylenes
Rifampin
Hematoma

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement : Results of the Citadel and Centurion Studies. / Henrikson, Charles A.; Sohail, M. Rizwan; Acosta, Helbert; Johnson, Eric; Rosenthal, Lawrence; Pachulski, Roman; Dan, Dan; Paladino, Walter; Khairallah, Farhat S.; Gleed, Kent; Hanna, Ibrahim; Cheng, Alan; Lexcen, Daniel R.; Simons, Grant R.

In: JACC: Clinical Electrophysiology, Vol. 3, No. 10, 01.10.2017, p. 1158-1167.

Research output: Contribution to journalArticle

Henrikson, CA, Sohail, MR, Acosta, H, Johnson, E, Rosenthal, L, Pachulski, R, Dan, D, Paladino, W, Khairallah, FS, Gleed, K, Hanna, I, Cheng, A, Lexcen, DR & Simons, GR 2017, 'Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement: Results of the Citadel and Centurion Studies', JACC: Clinical Electrophysiology, vol. 3, no. 10, pp. 1158-1167. https://doi.org/10.1016/j.jacep.2017.02.016
Henrikson, Charles A. ; Sohail, M. Rizwan ; Acosta, Helbert ; Johnson, Eric ; Rosenthal, Lawrence ; Pachulski, Roman ; Dan, Dan ; Paladino, Walter ; Khairallah, Farhat S. ; Gleed, Kent ; Hanna, Ibrahim ; Cheng, Alan ; Lexcen, Daniel R. ; Simons, Grant R. / Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement : Results of the Citadel and Centurion Studies. In: JACC: Clinical Electrophysiology. 2017 ; Vol. 3, No. 10. pp. 1158-1167.
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abstract = "Objectives This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. Background TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. Methods We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. Results Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4{\%}; 95{\%} confidence interval: 0.0{\%} to 0.9{\%}), significantly lower than the 12-month benchmark rate of 2.2{\%} (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7{\%} compared with an infection rate of 1.0{\%} and 1.3{\%} (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2{\%} compared with the published benchmark of 2.2{\%} (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6{\%}; 95{\%} confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6{\%}. Conclusions Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705)",
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T2 - Results of the Citadel and Centurion Studies

AU - Henrikson, Charles A.

AU - Sohail, M. Rizwan

AU - Acosta, Helbert

AU - Johnson, Eric

AU - Rosenthal, Lawrence

AU - Pachulski, Roman

AU - Dan, Dan

AU - Paladino, Walter

AU - Khairallah, Farhat S.

AU - Gleed, Kent

AU - Hanna, Ibrahim

AU - Cheng, Alan

AU - Lexcen, Daniel R.

AU - Simons, Grant R.

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N2 - Objectives This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. Background TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. Methods We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. Results Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4%; 95% confidence interval: 0.0% to 0.9%), significantly lower than the 12-month benchmark rate of 2.2% (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7% compared with an infection rate of 1.0% and 1.3% (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2% compared with the published benchmark of 2.2% (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6%; 95% confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6%. Conclusions Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705)

AB - Objectives This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. Background TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. Methods We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. Results Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4%; 95% confidence interval: 0.0% to 0.9%), significantly lower than the 12-month benchmark rate of 2.2% (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7% compared with an infection rate of 1.0% and 1.3% (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2% compared with the published benchmark of 2.2% (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6%; 95% confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6%. Conclusions Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705)

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