Clinical use of antibacterial mesh envelopes in cardiovascular electronic device implantations

Light-sensitive PEG hydrogel with antibacterial performance for pacemaker pocket infection prevention

Prevention of cardiovascular implantable electronic devices (CIED) infection is crucial for successful outcomes. In this study, we report an adhesive and antibacterial hydrogel coating for CIED infection treatment, by immobilizing polyethylene glycol (PEG) and 2'-O-hydroxypropyl trimethyl ammonium chloride chitosan (HAC) on Ti surface. Initial alkali and APTES treatment caused the formation of -NH2 to enhance the adhesion of the hydrogel coating to Ti implants, followed by immobilizing a photo-cross-linkable PEG/2'-O-HTACCS hydrogel on Ti/OH/NH2 surface. Surface characterization of Ti/OH/NH2 sample and adhesion testing of hydrogel on Ti/OH/NH2 surface confirm successful immobilization of hydrogel onto the Ti/OH/NH2 surface. In vitro and in vivo antimicrobial results exhibited that the photo-cross-linkable PEG/HAC composite hydrogel has excellent antimicrobial capabilities against both Grampositive (S. aureus and S. epidermidis) and Gram-negative (P. aeruginosa and E. coli) bacteria. The outcome of this study demonstrates the photo-cross linked PEG/HAC coating hydrogels can be easily formed on the Ti implants, and has great potential in preventing CIED pocket infection.

Absorbable antibacterial envelope in the surgical management of Twiddler's syndrome in a patient with gastric electric stimulator: a case report

Gastroparesis is a chronic gastric motility disorder characterized by delayed gastric emptying and a multitude of troublesome symptoms, including chronic nausea, vomiting, abdominal pain, malnutrition, and dehydration. Whereas initial management of the gastroparesis is conservative, patient with refractory gastroparesis may benefit from surgical therapy, including gastric electric stimulator (GES) device implantation. Twiddler’s syndrome is a challenging condition well described in the cardiac literature that is characterized by the instability, displacement, leads twisting and resulting malfunction of an implanted device, believed to be due to manipulation (twiddling) by the patient. The condition is not specifically characterized in the GES literature; however, evidence suggest the incidence of the Twiddler’s syndrome is reaching up to 9% of the patients with GES. In the current report we present a case of surgical management of the recurrent Twiddler’s syndrome in a patient with a GES device with novel non-FDA approved use of the TYRX^™ Absorbable Antibacterial Envelope for the device stabilization. Use of the TYRX^™ enveloped provided additional anchoring points of fixation, resulting in the successful resolution of the device instability and the Twiddler’s syndrome with and ongoing follow up of up to 8 months. This report adds to the armamentarium of surgical management of this uncommon and difficult problem.

Nanotechnology-based drug delivery systems for control of microbial biofilms: a review

Since the dawn of civilization, it has been understood that pathogenic microorganisms cause infectious conditions in humans, which at times, may prove fatal. Among the different virulent properties of microorganisms is their ability to form biofilms, which has been directly related to the development of chronic infections with increased disease severity. A problem in the elimination of such complex structures (biofilms) is resistance to the drugs that are currently used in clinical practice, and therefore, it becomes imperative to search for new compounds that have anti-biofilm activity. In this context, nanotechnology provides secure platforms for targeted delivery of drugs to treat numerous microbial infections that are caused by biofilms. Among the many applications of such nanotechnology-based drug delivery systems is their ability to enhance the bioactive potential of therapeutic agents. The present study reports the use of important nanoparticles, such as liposomes, microemulsions, cyclodextrins, solid lipid nanoparticles, polymeric nanoparticles, and metallic nanoparticles, in controlling microbial biofilms by targeted drug delivery. Such utilization of these nanosystems has led to a better understanding of their applications and their role in combating biofilms.

A meta-analysis of antibacterial envelope use in prevention of cardiovascular implantable electronic device infection

OBJECTIVES

Cardiac implantable electronic device (CIED) infection has been a major clinical problem in addition to being a major financial burden. In spite of antimicrobial prophylaxis, CIED infection rates have been increasing disproportionately. We therefore conducted this meta-analysis to assess the role of TYRX antibiotic envelope for the prevention of CIED infection.

METHODS

Using extensive online search, we conducted a meta-analysis of studies reporting CIED infections with versus without the use of TYRX antibiotic envelope. A random-effect model was used, and between studies heterogeneity was estimated with I². All analyses were performed with RevMan (version 5.0.20).

RESULTS

Five cohort studies were included in this meta-analysis. The pooled odds ratio (OR) of included studies was 0.29 [95% confidence interval (CI): 0.09-0.94; p < 0.004]. There was evidence of heterogeneity with I² of 58%. There was also evidence of publication bias on funnel plot analysis. On sensitivity analysis, no statistically significant difference was noted when stratified by study design or duration of follow-up.

CONCLUSION

The results of our study demonstrate a significant beneficial effect of TYRX antibiotic envelope for the prevention of CIED infections.