title: Real-World Use of Prophylactic Antibiotics in Insertable Cardiac Monitor Procedures.
abstract: BACKGROUND
  The use of prophylactic antibiotics during insertable cardiac monitor (ICM) procedures is a carryover of the common practice used with therapeutic cardiac implantable electronic devices. We sought to characterize the current practice of ICM insertion procedures to evaluate the influence of prophylactic antibiotic administration on the occurrence of infections.
  
  
  METHODS
  We characterized insertion procedures and procedure-related infections from an ongoing multicenter registry (Reveal LINQ(TM) Registry). In order to accurately capture infections, only patients enrolled before or the day of insertion who also had a record of whether or not preoperative antibiotics were used were included in this analysis. Infections were defined based on the physician's assessment and reported upon occurrence. Patients were categorized into two analysis cohorts based on prophylactic antibiotic use.
  
  
  RESULTS
  We analyzed 375 patients from 14 U.S. centers (age 63.1 ± 15.6 years; male 54.1%). Approximately two-thirds of patients (66.4%) did not receive any preprocedural antibiotics. The overall infection rate was 1.1% (0.3-2.7% confidence interval [CI]) and corresponded to four events. In the group that did not receive preprocedural antibiotics, there were two minor infections (0.8%, [0.1-2.9% CI]), whereas in the group receiving preprocedural antibiotics a serious and a minor infection occurred (1.6%, [0.2-5.6% CI]); this serious infection resulted in an explant.
  
  
  CONCLUSIONS
  Current real-world practice shows that ICM insertions are increasingly performed without the use of prophylactic antibiotics, which is associated with a very low infection rate.
authors.affiliation: Center for Cardiac and Vascular Research, Washington Adventist Hospital, Rockville, Maryland.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Beinart
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Medicine, University of California, Irvine, California.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.affiliation: Department of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Scott
authors.initials: S
authors.lastname: Kasner
authors.affiliation: Department of Neurology and Stroke Center, University Hospital Essen, Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Medtronic plc, Mounds View, Minnesota.
authors.forename: Erika
authors.initials: E
authors.lastname: Pouliot
authors.affiliation: Medtronic plc, Mounds View, Minnesota.
authors.forename: Noreli
authors.initials: N
authors.lastname: Franco
authors.affiliation: Electrophysiology Laboratory, The Valley Hospital Health System, Ridgewood, New Jersey.
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
mesh_terms: D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014600:Utilization Review
keywords: antibiotics; infections; insertable cardiac monitor; insertion procedure; safety