Senaratne Janek M, Jayasuriya Anushka, Irwin Marleen, Gulamhusein Sajad, Senaratne Manohara P J
Division of Cardiac Sciences, Grey Nuns Hospital, Edmonton, Alberta, Canada.
Pacing Clin Electrophysiol. 2014 Aug;37(8):947-54. doi: 10.1111/pace.12403. Epub 2014 Apr 26.
Although the incidence of pacemaker-related infection (PMINF) is low, it necessitates removal of the pacing system. There is currently no consensus on antibiotics during implantation.
A prospective database on patients undergoing pacemaker surgery from 1991 to 2009 was reviewed to determine factors associated with PMINF. Specifically, three eras of antibiotic use were compared to elucidate the effect of antibiotics on PMINF: no antibiotics, perioperative antibiotics, and peri- plus postoperative antibiotics.
There were 3,253 procedures with PMINF identified in 46 (1.4%) patients. Over 19 years, PMINF incidence fell from 3.6% (no antibiotics) to 2.9% (perioperative antibiotics), to 0.4% (peri- plus postoperative antibiotics). On univariate analysis, the following were associated with PMINF: nonuse of postoperative antibiotics (3.0% vs 0.4%, P < 0.001), year of implant (P < 0.001), repeat procedures (2.3% vs 1%, P = 0.006), nonuse of perioperative antibiotics (3.6% vs 1.3%, P = 0.027). With postoperative antibiotics, rates were significantly reduced in new implants (1/1,289 = 0.1% vs 22/967 = 2.3%, P < 0.001) and repeat procedures (7/692 = 1.0% vs 16/305 = 5.2%, P < 0.001). On multivariate analysis, the following were significant (standardized coefficients denote relative importance): postoperative antibiotics (0.776), repeat procedures (0.508), year of implant (0.142), perioperative antibiotics (0.088).
The PMINF rate is reduced significantly by perioperative antibiotics with a further significant reduction with postoperative antibiotics. However, the reduction in PMINF rate could be a result of changes in practice in the different time eras. This study suggests consideration of perioperative followed by postoperative antibiotics to minimize pacemaker infections.
尽管起搏器相关感染（PMINF）的发生率较低，但仍需要移除起搏系统。目前在植入过程中使用抗生素尚无共识。
回顾了1991年至2009年接受起搏器手术患者的前瞻性数据库，以确定与PMINF相关的因素。具体而言，比较了三个抗生素使用时期，以阐明抗生素对PMINF的影响：不使用抗生素、围手术期使用抗生素以及围手术期加术后使用抗生素。
在46例（1.4%）患者中识别出3253例伴有PMINF的手术。在19年期间，PMINF发生率从3.6%（不使用抗生素）降至2.9%（围手术期使用抗生素），再降至0.4%（围手术期加术后使用抗生素）。单因素分析显示，以下因素与PMINF相关：未使用术后抗生素（3.0%对0.4%，P<0.001）、植入年份（P<0.001）、重复手术（2.3%对1%，P = 0.006）、未使用围手术期抗生素（3.6%对1.3%，P = 0.027）。使用术后抗生素后，新植入手术的感染率显著降低（1/1289 = 0.1%对22/967 = 2.3%，P<0.001），重复手术的感染率也显著降低（7/692 = 1.0%对16/305 = 5.2%，P<0.001）。多因素分析显示，以下因素具有显著性（标准化系数表示相对重要性）：术后抗生素（0.776）、重复手术（0.508）、植入年份（0.142）、围手术期抗生素（0.088）。
围手术期使用抗生素可显著降低PMINF发生率，术后使用抗生素进一步显著降低该发生率。然而，PMINF发生率的降低可能是不同时期实践变化的结果。本研究建议考虑围手术期后使用术后抗生素，以尽量减少起搏器感染。
