A claim for using post-operative antibiotics in pacemaker related infections: an extended 19-year experience
Bibliographic record
Abstract
Purpose: Although the reported incidence of pacemaker related infection (PMINF) is low, it necessitates the removal of the pacing system for cure. The present study elucidates factors associated with PMINF over a 19 yr period. Methods: A retrospective chart review was conducted on all patients (pts) undergoing pacemaker surgery from 1991-2009. Implant and clinical follow-up data were collected prospectively and entered into an SPSS database. Results: There were 3253 procedures with PMINF identified in 46 (1.4%) pts. Time from last procedure: <1mo = 7 (15.2%); 1mo-1yr = 21 (45.7%); >1yr = 18 (39.1%). During the 19 yr period the incidence of PMINF fell from 3.6% (no antibiotics) to 2.9% (only peri-operative antibiotics – PERI = two doses iv cefazolin/clindamycin), to 0.4% (peri-operative plus post-operative antibiotics – PPOST = PERI + 4 day course of oral cephalexin/clindamycin). With PPOST, the infection rates were significantly reduced in both new implants (1/1289 = 0.1% vs. 22/967 = 2.3%, p<0.001) and repeat procedures (7/692 = 1.0% vs. 16/305 = 5.2%, p < 0.001). On univariate analysis, the following were associated with an increased risk of PMINF: non-use of PPOST (3.0% vs. 0.4%, p<0.001), repeat procedures (2.3% vs. 1%, p = 0.006), non-use of PERI (3.6% vs. 1.3%, p = 0.027). The following were not significant: surgical suite (procedure room vs. operating room); diabetes; local antibiotic use; age; gender; inpatient vs outpatient procedures. On multivariate analysis the following were significant (standardized coefficients denote relative importance of each): PPOST (0.886), repeat procedures (0.508), PERI (0.115). In the repeat procedures group, there was a trend in reduction of PMINF to 0.5% (1/188) from 2.7% (22/809, p = 0.101) when all prior procedures had PPOST administered. Conclusions: The present study confirms a small but definite risk of PMINF with a significant proportion manifesting beyond one year of implantation. The PMINF rate is reduced significantly by peri-operative antibiotics with a further significant reduction with the addition of post-operative antibiotics. Repeat procedures are associated with higher rates of PMINF which are also attenuated by PERI and PPOST. The trend towards a decrease in the PMINF for repeat procedures where all prior procedures had PPOST suggests the higher rate of PMINF for repeat procedures may be related to recrudescence of bacterial colonization at the time of the original procedure as opposed to new PMINF. The present study makes a strong case for the use of an extended course of post-operative antibiotics to minimize pacemaker related infections.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".