{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:13:58Z","timestamp":1790187238897,"version":"4.1.0"},"reference-count":37,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T00:00:00Z","timestamp":1537228800000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X18001708_abs1\" sec-type=\"general\"><jats:title>Background<\/jats:title><jats:p>The rate of cardiovascular implantable electronic device (CIED) infection is increasing coincident with an increase in the number of device procedures. Preprocedural antimicrobial prophylaxis reduces CIED infections; however, there is no evidence that prolonged postprocedural antimicrobials additionally reduce risk. Thus, we sought to quantify the harms associated with this approach.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001708_abs2\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>To measure the association between<jats:italic>Clostridium difficile<\/jats:italic>infection (CDI), acute kidney injury (AKI) and receipt of prolonged postprocedural antimicrobials.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001708_abs3\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) database during fiscal years 2008\u20132016 were included. The primary outcome was 90-day incidence of CDI and the secondary outcome was the 7-day incidence of AKI. The primary exposure measure was duration of postprocedural antimicrobial therapy. Associations were measured using Cox-proportional hazards and binomial regression.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001708_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Prolonged postprocedural antimicrobial therapy was identified following 3,331 of 6,497 CIED procedures (51.3%), and the median duration of prophylaxis was 5 days. Prolonged postprocedural antimicrobial use was associated with increased risk of CDI (hazard ratio [HR], 2.90; 95% confidence interval [CI], 1.54\u20135.46). Of the 27 patients who developed CDI, 11 subsequently died. Postprocedural antimicrobial use with \u22652 antimicrobials was associated with an increased risk of AKI (OR, 4.16; 95% CI, 2.50\u20136.90). The impact was particularly significant when one of the dual agents prescribed was vancomycin (adjusted OR, 8.41; 95% CI, 5.53\u201312.79).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001708_abs5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Prolonged antimicrobial prophylaxis following CIED procedures increases preventable harm; this practice should be discouraged in procedural settings such as the cardiac electrophysiology laboratory.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2018.170","type":"journal-article","created":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T09:33:41Z","timestamp":1537263221000},"page":"1030-1036","source":"Crossref","is-referenced-by-count":20,"title":["Prolonged antimicrobial prophylaxis following cardiac device procedures increases preventable harm: insights from the VA CART program"],"prefix":"10.1017","volume":"39","author":[{"given":"Archana","family":"Asundi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Stanislawski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payal","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna E.","family":"Bar\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Mull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpana","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Westyn","family":"Branch-Elliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,9,18]]},"reference":[{"key":"S0899823X18001708_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2017.08.026"},{"key":"S0899823X18001708_ref35","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.0874"},{"key":"S0899823X18001708_ref34","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.441"},{"key":"S0899823X18001708_ref32","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt129"},{"key":"S0899823X18001708_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2016.03.008"},{"key":"S0899823X18001708_ref29","doi-asserted-by":"publisher","DOI":"10.1007\/BF03086226"},{"key":"S0899823X18001708_ref27","doi-asserted-by":"publisher","DOI":"10.1177\/2042018816638223"},{"key":"S0899823X18001708_ref25","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.25.2916"},{"key":"S0899823X18001708_ref21","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis944"},{"key":"S0899823X18001708_ref20","doi-asserted-by":"publisher","DOI":"10.1186\/cc5713"},{"key":"S0899823X18001708_ref19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7812\/TPP\/15-049","article-title":"Predicting the risk of Clostridium difficile infection upon admission: a score to identify patients for antimicrobial stewardship efforts","volume":"20","author":"Kuntz","year":"2016","journal-title":"Perm J"},{"key":"S0899823X18001708_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr508"},{"key":"S0899823X18001708_ref16","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.309"},{"key":"S0899823X18001708_ref12","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2010.083"},{"key":"S0899823X18001708_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.1998.tb04785.x"},{"key":"S0899823X18001708_ref6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192665"},{"key":"S0899823X18001708_ref5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.108.816868"},{"key":"S0899823X18001708_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.04.033"},{"key":"S0899823X18001708_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.017"},{"key":"S0899823X18001708_ref1","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2014-000177"},{"key":"S0899823X18001708_ref8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.108.795906"},{"key":"S0899823X18001708_ref22","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1086\/421095","article-title":"Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project","volume":"38","author":"Bratzler","year":"2004","journal-title":"Clin Infect Dis"},{"key":"S0899823X18001708_ref9","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp120568"},{"key":"S0899823X18001708_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.05.016"},{"key":"S0899823X18001708_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(00)00469-3"},{"key":"S0899823X18001708_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw172.1174"},{"key":"S0899823X18001708_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir301"},{"key":"S0899823X18001708_ref14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002340"},{"key":"S0899823X18001708_ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"S0899823X18001708_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.116"},{"key":"S0899823X18001708_ref36","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12826"},{"key":"S0899823X18001708_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.08.045"},{"key":"S0899823X18001708_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2012.03506.x"},{"key":"S0899823X18001708_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2014.11.003"},{"key":"S0899823X18001708_ref24","unstructured":"R: A language and environment for statistical computing. [computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2017."},{"key":"S0899823X18001708_ref23","unstructured":"Epitools: Epidemiology Tools. R package [computer program] version 0.5-9 2017."},{"key":"S0899823X18001708_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.09.090"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X18001708","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T20:10:40Z","timestamp":1662063040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X18001708\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":37,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["S0899823X18001708"],"URL":"https:\/\/doi.org\/10.1017\/ice.2018.170","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]}}}