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. Similarly, in a cohort study from Olmsted County, Minne- sota, 55% of 22 patients with cardiac devices and subsequent S aureus bacteremia had definite or possible CIED infec- tion.17 In contrast, the risk of device infection with bacteremia with Gram-negative bacilli was substantially lower.27 Johansen et al28 followed up 36 076 patients in the Danish Pacemaker Register. The incidence of explantation due to infection was significantly higher after replacement proce- dures than after first implantation (2.06% versus 0.75%, P 0.01). Device revision was associated with CIED infec- tion in another investigation described recently.19 Although the incidence of infection decreased in the past 3 years of the study, the shorter follow-up of patients was thought to be a possible explanation. Whether multiple device revisions in- crease the risk of CIED infection exponentially is undefined. The importance of reinterventions and device replacement is highlighted in the current era of increased safety alerts and device advisories. Gould and Krahn29 reported that in Can- ada, the risk of major complications of ICD replacement in response to recalls that required reoperation was 5.8% (31 of 533 patients), which included 2 deaths after extraction for pocket infection. Kapa et al30 reported a 1.4% complication risk at Mayo Clinic. 