Lee Wen-Huang, Huang Ting-Chun, Lin Li-Jen, Lee Po-Tseng, Lin Chih-Chan, Lee Cheng-Han, Chao Ting-Hsing, Li Yi-Heng, Chen Ju-Yi
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Tainan, Taiwan.
Clin Cardiol. 2017 Aug;40(8):559-565. doi: 10.1002/clc.22698. Epub 2017 Apr 26.
Despite limited evidence, postoperative prophylactic antibiotics are often used in the setting of permanent pacemaker implantation or replacement. The aim of this study is to investigate the efficacy of postoperative antibiotics.
Postoperative prophylactic antibiotics may be not clinically useful.
We recruited 367 consecutive patients undergoing permanent pacemaker implantation or generator replacement at a tertiary referral center. Baseline demographics, clinical characteristics, and procedure information were collected, and all patients received preoperative prophylactic antibiotics. Postoperative prophylactic antibiotics were administered at the discretion of the treating physician, and all patients were seen in follow-up every 3 to 6 months for an average follow-up period of 16 months. The primary endpoint was device-related infection.
A total of 110 patients were treated with preoperative antibiotics only (group 1), whereas 257 patients received both preoperative and postoperative antibiotics (group 2). After a mean follow-up period of 16 months, 1 patient in group 1 (0.9%) and 4 patients in group 2 (1.5%) experienced a device-related infection. There was no significant difference in the rate of infection between the 2 groups (P = 0.624). In the univariate analysis, only the age (60 ± 11 vs 75 ± 12 years, P < 0.001) was significantly different between the infected and noninfected groups. In the multivariate analysis, younger age was an independent risk factor for infective complications (odds ratio = 1.08, P = 0.016).
Patients treated with preoperative and postoperative antibiotics had a similar rate of infection as those treated with preoperative antibiotics alone. Further studies are needed to confirm these preliminary findings.
尽管证据有限，但永久性起搏器植入或更换时通常会使用术后预防性抗生素。本研究的目的是调查术后抗生素的疗效。
术后预防性抗生素可能在临床上并无用处。
我们在一家三级转诊中心招募了367例连续接受永久性起搏器植入或发生器更换的患者。收集了基线人口统计学、临床特征和手术信息，所有患者均接受术前预防性抗生素治疗。术后预防性抗生素由治疗医生酌情使用，所有患者每3至6个月接受一次随访，平均随访期为16个月。主要终点是与器械相关的感染。
共有110例患者仅接受术前抗生素治疗（第1组），而257例患者接受了术前和术后抗生素治疗（第2组）。平均随访16个月后，第1组有1例患者（0.9%）和第2组有4例患者（1.5%）发生了与器械相关的感染。两组之间的感染率无显著差异（P = 0.624）。在单因素分析中，仅感染组和未感染组之间的年龄有显著差异（60±11岁对75±12岁，P < 0.001）。在多因素分析中，年龄较小是感染性并发症的独立危险因素（比值比 = 1.08，P = 0.016）。
接受术前和术后抗生素治疗的患者与仅接受术前抗生素治疗的患者感染率相似。需要进一步研究来证实这些初步发现。
