Chapter 6 96 and Staphylococcus aureus was the most frequently isolated pathogen (40%). Almost all patients had complete removal of their CIED system (90%). The median PADIT score in patients with a CIED infection in the first year after the procedure was 6 (IQR, 4–8). The PADIT score showed good discrimination in predicting CIED infection requiring hospitalization within the first year (C-statistic 0.70; 95% CI 0.54–0.86, P = 0.03). The optimal cut-off was a PADIT score of ≥ 7 resulting in a sensitivity of 50% and a specificity of 83% for predicting CIED infection. Patients with a PADIT score ≥ 7 had a higher risk of hospitalization for CIED infection within the first year than patients with a lower PADIT score (1.23% vs. 0.26%, P = 0.02; odds ratio 4.8, 95% CI 1.4–16.6, P = 0.01). In the 1117 patients who can be considered potential WRAP-IT candidates (i.e., CIED reoperations and initial CRT-D implantation) the incidence of CIED infection within the first year after the procedure was 0.45% (95% CI 0.15–1.04%). Of the study population, a total of 130 patients (5.6%) died within 1 year of the procedure (cardiovascular death 32%, non-cardiovascular death 25%, unknown cause 44%). None of these 130 patients had a hospitalization for CIED infection. 4. Discussion The present study demonstrates that the risk of device infection can be low (0.43%) when strict adherence to preventive measures for CIED infections is used. The PADIT score was useful in identifying patients at high risk of CIED infection. For our tertiary referral center, a PADIT score ≥ 7 had the highest sensitivity and specificity for predicting CIED infection requiring hospitalization with a 1-year risk of 1.23%. Identification of this high-risk population for CIED infection is useful because they can potentially benefit from adjunctive preventive measures like an antibiotic envelope. 4.1. Risk of CIED infection CIED infection is associated with significant morbidity, increased hospitalizations, reduced survival, and financial health care burden (12). The large prospective PADIT trial (n = 19,603) demonstrated a 1-year infection rate of 0.9% (2). It is important to note that most patients in the PADIT trial were high-risk patients (66%) who
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