This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Da Costa, A. Articles by Touboul, P. Search for Related Content PubMed PubMed Citation Articles by Da Costa, A. Articles by Touboul, P. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB AMOXICILLIN CEFAZOLIN CLOXACILLIN PENICILLIN G Medline Plus Health Information Pacemakers and Implantable Defibrillators

(Circulation. 1998;97:1796-1801.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Antibiotic Prophylaxis for Permanent Pacemaker Implantation

A Meta-Analysis

Antoine Da Costa, MD; Gilbert Kirkorian, MD; Michel Cucherat, MD; François Delahaye, MD; Philippe Chevalier, MD, PhD; Alexis Cerisier, MD; Karl Isaaz, MD; ; Paul Touboul, MD

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.

Key Words: pacemakers • meta-analysis • prevention

This article has been cited by other articles:

				J. N. Khan, N. Prasad, and J. Glancy Letter by Khan et al Regarding Article "Efficacy of Antibiotic Prophylaxis Before the Implantation of Pacemakers and Cardioverter-Defibrillators: Results of a Large, Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial" Circ Arrhythmia Electrophysiol, June 1, 2009; 2(3): e13 - e13. [Full Text] [PDF]

				M. Maytin and L. M. Epstein Proof Positive: Efficacy of Antibiotic Prophylaxis in Device Implantation Circ Arrhythmia Electrophysiol, February 1, 2009; 2(1): 4 - 5. [Full Text] [PDF]

				Efficacy of Antibiotic Prophylaxis Before the Implantation of Pacemakers and Cardioverter-Defibrillators: Results of a Large, Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial Circ Arrhythmia Electrophysiol, February 1, 2009; 2(1): 29 - 34.

				K. Rajappan Permanent pacemaker implantation technique: part I Heart, February 1, 2009; 95(3): 259 - 264. [Full Text] [PDF]

				M. Pichlmaier, V. Marwitz, C. Kuhn, M. Niehaus, G. Klein, C. Bara, A. Haverich, and W.-R. Abraham High prevalence of asymptomatic bacterial colonization of rhythm management devices Europace, September 1, 2008; 10(9): 1067 - 1072. [Abstract] [Full Text] [PDF]

				H. M. Spotnitz Surgical Implantation of Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2008; 3(2008): 1395 - 1428. [Full Text]

				M. M. Gallagher, L. Santini, G. Magliano, M. Sgueglia, F. Venditti, M. Padula, and F. Romeo Feasibility and safety of a simplified draping method for pacing procedures Europace, October 1, 2007; 9(10): 890 - 893. [Abstract] [Full Text] [PDF]

				D. Klug, M. Balde, D. Pavin, F. Hidden-Lucet, J. Clementy, N. Sadoul, J. L. Rey, G. Lande, A. Lazarus, J. Victor, et al. Risk Factors Related to Infections of Implanted Pacemakers and Cardioverter-Defibrillators: Results of a Large Prospective Study Circulation, September 18, 2007; 116(12): 1349 - 1355. [Abstract] [Full Text] [PDF]

				M.-R. Movahed, B. Kasravi, and C. S. Bryan Prophylactic Use of Vancomycin in Adult Cardiology and Cardiac Surgery Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2004; 9(1): 13 - 20. [Abstract] [PDF]

				L. M. Baddour, M. A. Bettmann, A. F. Bolger, A. E. Epstein, P. Ferrieri, M. A. Gerber, M. H. Gewitz, A. K. Jacobs, M. E. Levison, J. W. Newburger, et al. Nonvalvular Cardiovascular Device-Related Infections Circulation, October 21, 2003; 108(16): 2015 - 2031. [Full Text] [PDF]

				L. Leibovici, K. Soares-Weiser, M. Paul, E. Goldberg, A. Herxheimer, and P. Garner Considering resistance in systematic reviews of antibiotic treatment J. Antimicrob. Chemother., October 1, 2003; 52(4): 564 - 571. [Abstract] [Full Text] [PDF]

				A. del Rio, I. Anguera, J. M. Miro, L. Mont, V. G. Fowler Jr, M. Azqueta, and C. A. Mestres Surgical Treatment of Pacemaker and Defibrillator Lead Endocarditis: The Impact of Electrode Lead Extraction on Outcome Chest, October 1, 2003; 124(4): 1451 - 1459. [Abstract] [Full Text] [PDF]

				H. M. Spotnitz Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2003; 2(2003): 1293 - 1326. [Full Text]

				M. Yamada, S. Takeuchi, Y. Shiojiri, K. Maruta, A. Oki, K. Iyano, and T. Takaba Surgical lead-preserving procedures for pacemaker pocket infection Ann. Thorac. Surg., November 1, 2002; 74(5): 1494 - 1499. [Abstract] [Full Text] [PDF]

				D. J. Kirse, A. H. Werle, J. V. Murphy, T. P. Eyen, D. E. Bruegger, G. W. Hornig, and R. D. Torkelson Vagus Nerve Stimulator Implantation in Children Arch Otolaryngol Head Neck Surg, November 1, 2002; 128(11): 1263 - 1268. [Abstract] [Full Text] [PDF]

				Antibiotic Prophylaxis Reduces Infection During Pacemaker Implantation Journal Watch (General), May 19, 1998; 1998(519): 5 - 5. [Full Text]

				A. Da Costa, H. Lelievre, H. PhaD, G. Kirkorian, M. Celard, P. Chevalier, F. Vandenesch, J. Etienne, and P. Touboul Role of the Preaxillary Flora in Pacemaker Infections : A Prospective Study Circulation, May 19, 1998; 97(18): 1791 - 1795. [Abstract] [Full Text] [PDF]