(Level of Evidence: C) Complications of Device Infection Complications of CIED infection can be either contiguous to the device or anatomically remote. Contiguous complications include chest wall abscess, septic thrombophlebitis, and right-sided heart endocarditis. More remote complications include skeletal complications, both local (clavicular osteo- myelitis and sternoclavicular arthritis) and remote (metastatic osteomyelitis, discitis, and septic arthritis); cardiopulmonary complications (septic pulmonary emboli, mycotic pulmonary artery aneurysm, and left-sided endocarditis with its potential complications); metastatic complications, including soft tis- sue and organ or muscle abscess formation; and sepsis, with its potential complications. Outcomes CIED infection is a serious complication associated with substantial morbidity, mortality, and cost.8,28,56,82 Reported mortality rates for these infections range widely and tend to be higher in patients with confirmed device-related endocarditis and in those treated without device removal (Table 2).23,24,28,56,83 87 Because of a lack of adequate comparison groups, substantial heterogeneity among stud- ies, and marked differences in populations who do and do not receive device removal, precise estimates of the benefits of device removal are not available. A risk factor analysis88 was conducted that examined clinical and echocardiographic variables that identified pa- tients with CIED infections who were at increased risk of mortality. All-cause mortality at 6 months among 210 pa- tients with CIED infections was 18%. Variables associated with increased mortality risk among this cohort included systemic embolization, moderate to severe tricuspid regurgi- tation, abnormal right ventricular function, and abnormal renal function. Size and mobility of lead vegetations were not independently associated with mortality. Prevention Prophylaxis at CIED Implantation Prevention of CIED infection can be addressed before, during, and after device implantation. Before device implan- tation, it is important to ensure that patients do not have clinical signs of infection. A parenterally administered anti- biotic is recommended 1 hour before the procedure. 