Bru P, Cointe R, Metge M, Mallet M N, Moyal C, Dolla E, Collet F, Gérard R, Lévy S
Service de Cardiologie, Centre Hospitalier d'Angoulême, Saint-Michel.
Ann Cardiol Angeiol (Paris). 1991 Apr;40(4):171-4.
The aim of this study was to assess the usefulness of prophylactic antibiotics during insertion of a cardiac pacemaker, in order to avoid infection of exteriorisation of infectious origin. The study involved two groups. One hundred and eight patients made up group I, a control group without the use of prophylactic antibiotics. Group II consisted of 101 patients who were given an intravenous injection of 1 or 2 g of oxacillin before surgery, followed up by four days of oral oxacillin (3 g per day). Serum oxacillin levels at the end of the procedure were 0.37 +/- 0.09 mcg/ml, falling within the range of minimum inhibitory concentrations of methicillin-sensitive staphylococci. In the patients of the control group, followed up for 1 to 36 months (mean 12 +/- 11 months), during the first 2 months there were 2 infections, 4 exteriorisations and one cutaneous erosion over the pacemaker. In addition, one exteriorisation and one infection occurred at 17 and 29 months respectively. In patients with exteriorisation of their pacemaker device, there was nothing to suggest an infection and bacteriological specimens were sterile. No obvious infections nor any cutaneous complications occurred in the patients of group II, with prophylactic antibiotics, followed up for 1 to 21 months (mean 6 +/- 5 months). In conclusion, anti-staphylococcal antibiotic treatment appears not only to be capable of avoiding cardiac pacemaker infections but also of preventing exteriorisation of the pacemaker device, which may be linked to hidden infections. A randomised study is nevertheless necessary to confirm this hypothesis.
本研究的目的是评估在植入心脏起搏器时预防性使用抗生素的有效性，以避免感染源引起的外部感染。该研究涉及两组。108名患者组成第一组，即未使用预防性抗生素的对照组。第二组由101名患者组成，这些患者在手术前静脉注射1或2克苯唑西林，随后口服苯唑西林4天（每天3克）。手术结束时血清苯唑西林水平为0.37±0.09微克/毫升，处于对甲氧西林敏感葡萄球菌的最低抑菌浓度范围内。在对照组患者中，随访1至36个月（平均12±11个月），在前2个月中有2例感染、4例外部感染和1例起搏器部位皮肤糜烂。此外，分别在17个月和29个月时发生1例外部感染和1例感染。在起搏器外部感染的患者中，未发现感染迹象，细菌学标本无菌。在使用预防性抗生素的第二组患者中，随访1至21个月（平均6±5个月），未发生明显感染或任何皮肤并发症。总之，抗葡萄球菌抗生素治疗似乎不仅能够避免心脏起搏器感染，还能防止起搏器装置的外部感染，这可能与隐匿性感染有关。然而，仍需要进行一项随机研究来证实这一假设。
