Risk Factors Several studies have identified characteristics associated with CIED infections. In a single-center case-control study,18 case subjects were more likely to have diabetes mellitus and heart failure and to have undergone generator replacement; renal dysfunction (glomerular filtration rate 60 mL min 1 ) had the strongest (odds ratio [OR] 4.8) association with CIED infection. Renal dysfunction was also associated with risk of CIED infection in a more recent nested case-control investigation.19 In addition, Lekkerkerker et al19 identified oral anticoagulant use as an associated risk factor for infec- tion. In another single-center case-control study, 29 patients with PPM infection were included, and long-term corticoste- roid use (OR 13.9) and the presence of more than 2 pacing leads (OR 5.41) were identified as independent correlates of In addition to patient factors, procedural characteristics may also play an important role in the development of CIED infection. In a prospective cohort of 6319 patients receiving CIED implantation in 44 medical centers, Klug et al21 identified 42 patients who developed CIED infection during 1 year of follow-up. The factors associated with an increased risk of infection included fever within 24 hours before implantation (OR 5.83), use of preprocedural temporary pacing (OR 2.46), and early reintervention (OR 15.04). 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. 