Implantation of a new system (OR 0.46 compared with partial or complete system replacement) and use of peripro- cedural antimicrobial prophylaxis (OR 0.40) were both asso- ciated with a lower risk of infection. The latter finding corroborated other evidence supporting perioperative antimi- crobial prophylaxis for CIED infection prevention.20,22 Other small studies suggest that pectoral transvenous device place- ment is associated with significantly lower rates of CIED infection than for those implanted abdominally15 or by thoracotomy.23,24 Thus, the pervasive use of a pectoral ap- proach is not only less invasive but also appears to confer an ancillary benefit of lower infection risk. Physician experience in CIED implantation may also play a role in the rate of subsequent CIED infection. In a study of Medicare administrative data, Al-Khatib et al25 found a significantly higher risk of ICD infection within 90 days of device implantation in patients whose device was placed by physicians in the lowest quartile of implantation volume (OR 2.47 compared with physicians in the highest-volume quar- tile). Rates of mechanical complications at 90 days were also higher for lower-volume physicians. Finally, among patients with bloodstream infection, the organism involved is strongly associated with the likelihood of serving as a manifestation of CIED infection, even in patients with no other evidence of CIED infection. In a cohort of 33 patients with implanted devices and subsequent Staph- ylococcus aureus bacteremia,26 nearly one half (45.4%) had confirmed CIED infection, and only a minority had local signs or symptoms that suggested generator-pocket infection. 