Suspected CIED systemic infection in adults: Initial approach to evaluation and management

CIED: cardiac implantable electronic device; TEE: transesophageal echocardiogram; TTE: transthoracic echocardiogram.

* Signs and symptoms of endocarditis include new murmur, new regurgitation, vegetation, paravalvular leak, evidence of pulmonary or systemic emboli, and immune phenomena. Refer to UpToDate text for further discussion.

¶ Vancomycin dosing consists of 15 to 20 mg/kg/dose intravenously every 8 to 12 hours (not to exceed 2 g per dose); in patients presenting with severe sepsis, broadening of parenteral therapy to include gram-negative bacteria is appropriate. Refer to UpToDate text for further discussion.

Δ Swabs and tissue from the pocket should be sent for culture, in addition to lead tips.

◊ The choice of antibiotic regimen is guided by blood culture results (refer to UpToDate text). The duration of antibiotic therapy (4 to 6 weeks) should be counted from the day of device explanation, if warranted.