Perspective:

It is important to note that all patients in the PADIT trial received prophylactic antibiotic therapy, either conventional prophylaxis with cefazolin, or more intense prophylaxis with cefazolin plus vancomycin, bacitracin pocket wash during implantation, and 2 days of post-implantation cefazolin. The infection rates were equally low with both prophylaxis regimens (1-1.2%). The risk score developed in the present study might be clinically useful in some situations. For example, if the risk score is very high, it might be decided to forego another replacement at implantable cardioverter-defibrillator (ICD) end-of-life in a patient with a primary prevention ICD who already has had 1-2 prior replacements and who has never required an ICD therapy.