Pacemakers: antibiotic prophylaxis reduces infection rate.

Clinical bottom line (level 1a)

  1. Patients undergoing permanent pacemaker insertion who receive antibiotic prophylaxis are less likely to develop infection (NNT = 37 at 18 months) .
Da Costa et al: Circulation 1998; 97: 1796-1801
Expires July 2003

The study

Systematic review of randomised controlled trials of
  • Patients: with permanent pacemakers inserted
  • Intervention: systemic antibiotics (penicillins or cephalosporins, for 6 hours to 8 days) compared with placebo
  • Outcome: any infection (generally infection around the pacemaker or systemic signs of infection)


    • Articles found in all using MEDLINE, EMBASE, Current Contents, 1967 to 1996 (search terms: not detailed ) and searching conference abstracts, article bibliographies, and contacting researchers and manufacturers to identify unpublished studies

    Selection criteria: as above
    Appraisal criteria: not given
    Articles excluded if:

    seven randomised controlled trials (one double-blinded)- 2023 patients followed for one month to four years; mean 14 to 23 months

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    infection 18 months 37/1012
    (3.7%)    		 0.256
    (0.10 to 0.656)     		37
    (30 to 81)

    • Death rate following pacemaker insertion was 37/2023 (1.8%).

    Citation

    1. Da Costa A, Kirkorian , Cucherat M, et al: Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998; 97: 1796-1801
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer:

    Clinical Question.
    Patient permanent pacemakers
    Intervention or Exposure antibiotics
    Comparison placebo
    Outcome infection