297 Antimicrobial prophylaxis before defibrillator and pace-maker implantation : a retrospective study

BackgroundThe implantation of pace maker or defibrillator expose to the risk of infection of these devices. The use of antimicrobial prophylaxis before implantation is not clearly recommended, because there are only few studies that establish its benefit.Patients and methodsWe conducted a retrospective case control study between 2004 and 2007, to determine the risk factor associated with infection, especially if the administration of an antimicrobial prophylaxis is associated with decrease of devices infection. Inclusion criteria were following: presence of wound inflammation, or device externalisation, and Klug's modified Dukes criteria for endocarditis. All micro-organisms results from deep wound sample or blood culture.Results979 patients had a non valvular cardiac device during the study period. 34 of them developed infectious complication (incidence 3.5%) : 19 local infections, and 15 endocarditis. 70 patients constituted the age and sex matched control population. Staphylococcus was isolated in 88% of the cases. 27% of them were S. aureus. 53% of Staphylococcus were resistant to meticillin. The risk factors associated with infection were following : number of surgical interventions related to the cardiac devices (p<0.001), early wound inflammation or hematoma (p<0.001), INR or partial thromboplastin time ratio > 1.5 the day of implantation, fever before implantation (p< 0.001), more infections after defibrillator implantation vs pace maker (p=0.03) and absence of antibioprohylaxis (p=0.03). Antibioprophyxis were in majority of case intra venous cephalosporin (16/17).ConclusionAntibioprophylaxis and surveillance of anticoagulation could be helpful to prevent infection after cardiac devices implantation; prospective studies could be interesting to confirm these results.Table. Risk factors for cardiac device infectionRisk factors for infectionpNumber of surgical operation related to cardiac devicep<0.001Early wound inflammation or hematomap<0.001INR or partial thromboplastin time ratio > 1.5p<0.015Fever before implantationp<0.001Defibrillator implantation versus pacemakerp=0.03Absence of antibioprophylaxisp