Methodological and Evidence Synthesis Quality Evaluation of MetaAnalyses Assessing the Effect of Antibacterial Envelopes to Reduce CIEDRelated Infections

Purpose: Antibacterial envelopes have been demonstrated to be therapeutically helpful in patients with Cardiac Implantable Electronic Devices (CIEDs). We examined the methodological and evidence synthesis quality of meta-analyses evaluating the effect of envelopes to reduce CIED infections. Methods: Full-text English systematic reviews published in peer-reviewed journals that described meta-analyses of the therapeutic efficacy of envelope on CIED-related infection were explored. A complete literature search was conducted from conception to September 27, 2021, using the electronic databases PubMed, Scopus, and Web of Science. On the 2nd of January 2022, the search was updated. Two reviewers independently screened the titles/abstracts and full-texts and extracted the data. The methodological quality of the included studies was assessed using the AMSTAR-2 tool. The GRADE technique was used to evaluate the quality of evidence synthesis. Results: Six reviews with a total of 15 outcomes were included. All of the reviews had a critically low methodological quality. Nine (60%) and six (40%) outcomes had low and moderate-quality evidence synthesis, respectively. Regarding the GRADE criteria, all outcomes were at risk of bias (n=15, 100%), followed by inconsistency (n=12, 80%), and publication bias (n=10, 67%). Researchers in the field should use the AMSTAR-2 scale and GRADE to perform high-quality studies in the future. Conclusion: To our knowledge, the current study is the first to analyze the methodological and evidence quality of systematic reviews providing meta-analyses on the effect of antibacterial envelopes on CIED-related infections. This is to help physicians, policymakers, and researchers to make better therapeutic decisions by revealing the methodological and evidence synthesis quality of systematic reviews.