How long should prophylactic antibiotics be prescribed for permanent pacemaker implantations? one day versus three days

Background: The implantation of a pacemaker is frequently a life-saving procedure. However, the process of implantation may carry an uncommon but potentially life-threatening infective complication. The prescription of prophylactic antibiotics is an effective way to reduce the risk of infection. The aim of the present study was to investigate the efficacy of 2 prophylactic antibiotic schemes and the possible risk factors associated with device-related infections. Methods: A total of 194 consecutive patients who received permanent pacemaker (PPM) implantations were enrolled in this study. Prophylactic antibiotics were prescribed for every patient with a duration of either 1 day or 3 days. The follow-up period was 3 months, and any event of device-related infection was recorded. Results: Out of the total 194 patients, there were 5 patients who experienced infective complications after PPM implantation (1 patient in the 1-day group and 4 patients in the 3-day group). The rate of infective complications showed no significant difference between the 2 kinds of antibiotic regimens (1.7% vs. 2.9%, p > 0.99). In the multivariate analysis, only the presence of pocket hematoma was an independent risk factor for infective complications (odds ratio = 3.14, p = 0.018). Conclusions: Our study showed that the efficacies for prevention of PPM-related infections were similar between the 1-day and 3-day regimens of prophylactic antibiotics. Pocket hematoma was an independent risk factor of infective complications, and a longer duration of antibiotic treatment may be considered for these patients. Otherwise, a 1-day course of antibiotic prophylaxis may be effective enough to prevent device-related infections, and may further reduce the lengths of hospitalizations.