MULTIFACTORIAL PREVENTION OF ENDOCARDITIS AND CARDIAC-PACEMAKER - A PROSPECTIVE-STUDY OF 207 PATIENTS

Infections after cardiac pacemaker implantation are rare (0.13 to 12.6 %) but potentially severe complications. Staphylococcus is the genus most frequently isolated (72 to 100 % of cases). The use of systematic prophylactic antibiotics remains controversial. From November 1991 to October 1993, 207 consecutive patients were submitted to a series of measures designed to reduce the risk of infection : a) intravenous bol us injection of Cefamindole, 15 minutes before implantation, b) cutane ous disinfection with iodinated polyvindone, c) injection of an ampoul e of rifampin before closure of the pacemaker in the pouch, d) absence of drainage system. Patients were predominantly female (60.9 %), with a mean age of 77 +/- 10 years, frequently suffering from heart diseas e (53.8 %). The indication for implantation was atrioventricular block (39.7 %), carotid sinus syndrome (27.5 %), atrial arrhythmia (27.5 %) , resection of the node-His tract (5.3 %). This procedure corresponded to the first implantation in 88.4 % or replacement of a previous pace maker in 11.6 % of cases and the pacing mode was single-chamber (38.4 % or replacement of a previous pacemaker in 11.6 % of cases and the pa cing mode was single-chamber (38.7 %), or double chamber (61.3 %). The mean duration of the procedure was 51.5 min +/- 30 min. The mean foll ow-up was 12.7 +/- 5 months. The overall mortality was 14 % (11 cases of cardiac failure, 6 sudden deaths, 4 cerebrovascular accidents, 4 ca ses of pneumonia, 4 neoplasms). Only one infectious problem (endocardi tis, i.e. 0.48 %) was observed.