From Service de Cardiologie (P.T.), Hôpital cardiovasculaire et
pneumologique, Lyon, France; and Service de Cardiologie (K.I.), Hôpital
Nord, Saint-Etienne, France.
Correspondence to Paul Touboul, MD, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon Montchat 69394 Lyon Cedex 03 France.
Background—Infection remains a
serious complication after permanent pacemaker implantation. Antibiotic
prophylaxis is frequently prescribed at the time of insertion to reduce
its incidence, although results of well-designed, controlled studies
are lacking.
Methods and Results—We performed a meta-analysis of all
available randomized trials to evaluate the effectiveness of antibiotic
prophylaxis to reduce infection rates after permanent pacemaker
implantation. Reports of trials were identified through a Medline,
Embase, Current Contents, and an extensive bibliography search. Trials
that met the following criteria were included: (1) prospective,
randomized, controlled, open or blind trials; (2) patients assigned to
a systemic antibiotic group or a control group; (3) end point events
related to any infection after pacemaker implantation: wound infection,
septicemia, pocket abscess, purulent secretion, right infective
endocarditis, inflammatory signs, a positive culture, septic
pulmonary embolism, or repeat operation for an infective
complication. Seven trials met the inclusion criteria. They included
2023 patients with established permanent pacemaker implantation (new
implants or replacements). The incidence of end point events in control
groups ranged from 0% to 12%. The meta-analysis suggested a
consistent protective effect of antibiotic pretreatment
(P=.0046; common odds ratio: 0.256, 95% confidence
interval: 0.10 to 0.656).
Conclusions—Results of the present meta-analysis
suggest that systemic antibiotic prophylaxis significantly reduces the
incidence of potentially serious infective complications after
permanent pacemaker implantation. They support the use of
prophylactic antibiotics at the time of pacemaker insertion
to prevent short-term pocket infection, skin erosion or septicemia.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Antibiotic Prophylaxis for Permanent Pacemaker Implantation
A Meta-Analysis
Key Words: pacemakers • meta-analysis • prevention
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