Efficacy of postoperative prophylactic antibiotics in reducing permanent pacemaker infections

Abstract

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.

Cardiac Implantable Electronic Device Infections: A Single Tertiary Care Center Experience

“…Still, the authors stated that infection rate was much lower than anticipated. [17] In a study carried out by Lee et al, [18] the patients treated with postoperative antibiotics were found to experience a similar rate of infection as those treated with not. A recent large multicenter study evaluating the strategies commonly used in clinical practice to reduce CIED infections found that prolonged use of antimicrobials after skin closure was not effective.…”

Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection

“…The efficacy of postoperative antibiotics has been studied in three studies. In a prospective, observational case‐control study, Lee et al investigated the use of postoperative antibiotic therapy in 367 patients with new pacemaker implantation or replacement. The patients with defibrillator and CRT device were excluded.…”

Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program

“…Preincisional antimicrobial prophylaxis is a mainstay of infection prevention in procedural settings. Although available evidence and surgical site infection prevention guidelines support only the use of a single preincisional dose, 4,13,22 continuation of antibiotics for >1 day is common following electrophysiology procedures. 3 Prior studies demonstrate that prolonged post-procedural antibiotics following device placement are considered the standard of care by clinical electrophysiologists.…”