Approach to evaluation and management of suspected infection of a cardiac implantable electronic device (CIED) in adults

TTE: transthoracic echocardiogram; TEE: transesophageal echocardiogram.
* Signs and symptoms of an isolated CIED pocket infection include pocket erythema, discomfort, swelling, incision dehiscence, deformation, and erosion.
¶ Signs and symptoms of endocarditis include new murmur, new regurgitation, vegetation, paravalvular leak, evidence of pulmonary or systemic emboli, and immune phenomena.
Δ 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.
◊ 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 explantation, if warranted.