Antibiotic prophylaxis in permanent pacemaker implantation: a prospective randomised trial

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Infections

Background:

• Pacemaker pocket infections are a serious complication of permanent pacemaker implantation.
• Evidence on the efficacy of antibiotic prophylaxis for preventing these infections is conflicting.
• A large prospective randomized trial was conducted to evaluate antibiotic prophylaxis and identify high-risk patients.

Purpose of the Study:

• To determine the efficacy of antibiotic prophylaxis in preventing pacemaker pocket infections.
• To identify patient-specific risk factors for developing infections after pacemaker implantation.

Main Methods:

• A prospective randomized open trial compared flucloxacillin (or clindamycin for penicillin allergy) with no antibiotic prophylaxis.
• Intravenous antibiotics were administered at implantation and continued for 48 hours.
• The primary endpoint was reoperation for an infective complication.

Main Results:

• In the randomized group, nine infections requiring reoperation occurred, all in the no-antibiotic group (P = 0.003).
• Across the total cohort, 13 infections were observed, with only one in the antibiotic group (P = 0.006).
• Infections were more common with inexperienced operators, prolonged procedures, or repeat operations for non-infective issues.

Conclusions:

• Antibiotic prophylaxis significantly decreased the incidence of infective complications requiring reoperation.
• Routine use of antibiotic prophylaxis is recommended for patients undergoing permanent pacemaker implantation.