Wrapping implantable cardiac implantable electronic devices (CIEDs) in an envelope that elutes antibiotics reduces the risk of major device infection, a clinical trial shows.

Nearly 7000 patients at increased risk of device infection were enrolled in the WRAP-IT trial and randomly allocated to have their device implanted as normal, or inserted wrapped in a polymer-coated knitted-mesh envelope that eluted minocycline and rifampin.

The rate of infections resulting in extraction or revision of the device, long-term antibiotic therapy with recurrence or death was 40% lower in patients allocated to the envelope, write the authors of the trial, funded by Medtronic, in the New England Journal of Medicine.

While 1.2% (42) patients in the usual-care group had such an infection, only 0.7% (25) with the envelope had infections, a result that was just statistically significant.