Morito Natsumi, Yamanouchi Yoshio, Kodama Sunao, Ohta Takeaki, Yahiro Eiji, Miyoshi Kei, Urata Hidenori
Department of Cardiology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Exp Clin Cardiol. 2006 Spring;11(1):21-4.
Despite paying careful attention to surgical details and sterile procedures, infection often occurs after pacemaker implantation. The prophylactic use of intravenously or orally administered antibiotics should therefore be considered. The present study aimed to evaluate the efficacy of orally administered levofloxacin (LVFX) as prophylaxis against pacemaker infection.
Thirty-nine patients who underwent permanent pacemaker implantation or pacemaker generator replacement due to battery depletion were included in the present study. Patients were divided into two groups (groups 1 and 2) and administered different antibiotics accordingly. Group 1 included 19 patients (75.7+/-9.3 years of age; 10 men and nine women) who were intravenously administered 2 g of cefazolin daily for five days postoperatively. Group 2 included 20 patients (73.7+/-14.4 years of age; 10 men and 10 women) who were orally administered 200 mg of LVFX 2 h before surgery and then 400 mg daily for five days thereafter.
In group 1, the mean white blood cell concentrations before, and one, four and seven days after surgery were 4979+/-1330/mm(3), 6453+/-1200/mm(3), 5463+/-1303/mm(3) and 5632+/-1154/mm(3), respectively, and in group 2, they were 5931+/-1316/mm(3), 7062+/-1774/mm(3), 5708+/-1402/mm(3) and 5345+/-1506/mm(3), respectively. In group 1, the mean blood C-reactive protein concentrations before, and one, four and seven days after surgery were 0.27+/-0.34 mg/dL, 0.48+/-0.48 mg/dL, 1.04+/-0.99 mg/dL and 0.52+/-0.48 mg/dL, respectively, and in group 2, they were 0.43+/-0.54 mg/dL, 0.52+/-0.27 mg/dL, 0.61+/-0.42 mg/dL and 0.56+/-0.63 mg/dL, respectively. The inflammatory parameters showed similar responses in both groups.
Orally administered LVFX following permanent pacemaker implantation can prevent pacemaker infection as successfully as intravenously administered cefazolin.
尽管在起搏器植入过程中已仔细关注手术细节和无菌操作，但感染仍常发生。因此，应考虑预防性使用静脉或口服抗生素。本研究旨在评估口服左氧氟沙星（LVFX）预防起搏器感染的疗效。
本研究纳入了39例因电池耗尽而接受永久性起搏器植入或起搏器发生器更换的患者。患者被分为两组（第1组和第2组），并相应地给予不同抗生素。第1组包括19例患者（年龄75.7±9.3岁；男性10例，女性9例），术后连续5天每天静脉注射2 g头孢唑林。第2组包括20例患者（年龄73.7±14.4岁；男性10例，女性10例），术前2小时口服200 mg LVFX，此后连续5天每天口服400 mg。
第1组手术前、术后1天、4天和7天的平均白细胞浓度分别为4979±1330/mm³、6453±1200/mm³、5463±1303/mm³和5632±1154/mm³，第2组分别为5931±1316/mm³、7062±1774/mm³、5708±1402/mm³和5345±1506/mm³。第1组手术前、术后1天、4天和7天的平均血C反应蛋白浓度分别为0.27±0.34 mg/dL、0.48±0.48 mg/dL、1.04±0.99 mg/dL和0.52±0.48 mg/dL，第2组分别为0.43±0.54 mg/dL、0.52±0.27 mg/dL、0.61±0.42 mg/dL和0.56±0.63 mg/dL。两组的炎症参数显示出相似的反应。
永久性起搏器植入后口服LVFX预防起搏器感染的效果与静脉注射头孢唑林一样成功。
