PADIT Infection Risk Score

CIED Pocket Infection & Endocarditis Risk Prediction

Predicts the risk of device-related infection following cardiac implantable electronic device (CIED) procedures. Guides antibiotic prophylaxis intensity and post-procedural monitoring. From the PADIT trial (Prevention of Arrhythmia Device Infection Trial).

Device revision/replacement/upgradeHigher risk than de novo implant

Prior CIED infectionPrevious pocket infection or lead endocarditis

Renal dysfunction (eGFR < 30 or dialysis)End-stage renal disease or severe CKD

ImmunosuppressionChronic steroids, chemotherapy, or immunosuppressive agents

Diabetes mellitusType 1 or Type 2

Oral anticoagulation or dual antiplateletIncreased hematoma risk → secondary infection risk

Pre-procedure fever or WBC > 11kActive infection concern at time of implant

Epicardial leadsEpicardial lead system

Results

PADIT Score 0

Risk Category —

Enter patient data above

Prophylaxis Recommendations

Low risk (0–4): Standard pre-operative IV cefazolin 1–2g. No additional prophylaxis needed beyond standard protocol.
Moderate risk (5–9): Standard antibiotics + consider enhanced surgical antisepsis. Post-procedure oral antibiotics for 2–5 days may be reasonable.
High risk (≥10): Consider incremental antibiotic prophylaxis (PADIT protocol: IV antibiotics + intraprocedural bacitracin wash + post-procedure oral antibiotics). TYRX antibacterial envelope may be considered.

Reference

Krahn AD et al. (2018) — Prevention of Arrhythmia Device Infection Trial (PADIT). NEJM. 380(18):1703–1713.