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Published on: September 24, 2021
Efficacy of postoperative prophylactic antibiotics in reducing permanent pacemaker infections
Wen-Huang Lee1, Ting-Chun Huang2, Li-Jen Lin3
1Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background:
Despite limited evidence, postoperative prophylactic antibiotics are often used in the setting of permanent pacemaker implantation or replacement. The aim of this study is to investigate the efficacy of postoperative antibiotics.
Hypothesis:
Postoperative prophylactic antibiotics may be not clinically useful.
Methods:
We recruited 367 consecutive patients undergoing permanent pacemaker implantation or generator replacement at a tertiary referral center. Baseline demographics, clinical characteristics, and procedure information were collected, and all patients received preoperative prophylactic antibiotics. Postoperative prophylactic antibiotics were administered at the discretion of the treating physician, and all patients were seen in follow-up every 3 to 6 months for an average follow-up period of 16 months. The primary endpoint was device-related infection.
Results:
A total of 110 patients were treated with preoperative antibiotics only (group 1), whereas 257 patients received both preoperative and postoperative antibiotics (group 2). After a mean follow-up period of 16 months, 1 patient in group 1 (0.9%) and 4 patients in group 2 (1.5%) experienced a device-related infection. There was no significant difference in the rate of infection between the 2 groups (P = 0.624). In the univariate analysis, only the age (60 ± 11 vs 75 ± 12 years, P < 0.001) was significantly different between the infected and noninfected groups. In the multivariate analysis, younger age was an independent risk factor for infective complications (odds ratio = 1.08, P = 0.016).
Conclusions:
Patients treated with preoperative and postoperative antibiotics had a similar rate of infection as those treated with preoperative antibiotics alone. Further studies are needed to confirm these preliminary findings.
Insights
Postoperative prophylactic antibiotics did not reduce infection rates in pacemaker patients. Preoperative antibiotics alone are as effective as adding postoperative doses, suggesting limited clinical benefit for extended antibiotic use.
Area of Science:
- Cardiology
- Infectious Disease
- Medical Device Technology
Background:
- Limited evidence supports routine postoperative prophylactic antibiotics for permanent pacemaker implantation.
- Current practice often includes postoperative antibiotics despite uncertain clinical utility.
Purpose of the Study:
- To investigate the efficacy of postoperative prophylactic antibiotics in preventing device-related infections after pacemaker procedures.
- To determine if adding postoperative antibiotics to preoperative prophylaxis offers additional benefit.
Main Methods:
- A prospective study of 367 patients undergoing pacemaker implantation or replacement.
- Patients received preoperative prophylactic antibiotics; postoperative antibiotics were administered at physician discretion.
- Primary endpoint was device-related infection, with an average follow-up of 16 months.
Main Results:
- No significant difference in device-related infection rates between patients receiving preoperative antibiotics only (0.9%) and those receiving both preoperative and postoperative antibiotics (1.5%).
- Younger age was identified as an independent risk factor for infective complications in multivariate analysis.
- The observed infection rates were statistically similar between the two antibiotic regimens (P = 0.624).
Conclusions:
- Postoperative prophylactic antibiotics do not appear to offer additional benefit in reducing infection rates for pacemaker patients.
- Preoperative antibiotic prophylaxis alone may be sufficient, warranting further investigation.
- Findings suggest a potential de-escalation of antibiotic use in this patient population.
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