ANTIBIOTIC-PROPHYLAXIS IN PACEMAKER SURGERY - A PROSPECTIVE-STUDY

To evaluate the effect of antibiotic prophylaxis in pacemaker surgery, 100 patients were randomly assigned to a prophylaxis group receiving cloxacillin or to a control group with no antibiotics. Cloxacillin was given i.v. (2g) 2 h before operation, followed by 1 g every 6 h for 2 days and the same dose perorally for 8 more days postoperatively. Adequate plasma concentrations were obtained in all patients. The follow-up time was 1-43 mo. The infection rate was 2% (1/50) in the prophylaxis group and 14% (7/50) in the control group (P < 0.05). The interval from operation to manifest infection was 9-35 days. In the control group the causal microorganism was Staphylococcus aureus in 2 patients, S. epidermidis in 2 and unknown in 3 patients. In the only patient with infection in the prophylaxis group, a methicillin-resistant S. epidermidis was isolated. Infection was initially localized to the pacemaker pocket in 7 patients, but septicemia developed in 1 of them and endocarditis in another. In 1 patient septicemia appeared initially, without local signs of infection. This study suggests that cloxacillin prophylaxis is of value in routine pacemaker surgery.