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

TEE: transesophageal echocardiogram; FDG PET/CT: fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography; SPECT/CT: radiolabeled autologous white blood cell single-photon emission computed tomography with computed tomography; MRSA: methicillin-resistant Staphylococcus aureus.
* Refer to separate UpToDate algorithm for approach to patients with systemic symptoms, positive blood cultures, and/or vegetation on TEE.
¶ FDG PET/CT may be useful to distinguish between CIED pocket infection and superficial site infection in some circumstances; refer to the UpToDate topic on diagnosis of CIED infection for further discussion.
Δ Oral antibiotic dosing as follows:

• Cephalexin 500 mg orally 4 times daily
• Clindamycin 300 to 450 mg orally 4 times daily (use higher dose for patients with weight >120 kg)
• Dicloxacillin 500 mg orally 4 times daily
• Doxycycline 100 mg orally twice daily
• Linezolid 600 mg orally twice daily
• Minocycline 200 mg orally once, then 100 mg orally every 12 hours
• Trimethoprim-sulfamethoxazole 1 to 2 double-strength tablets orally every 12 hours

◊ We favor initial therapy with vancomycin (15 to 20 mg/kg/dose intravenously every 8 to 12 hours [not to exceed 2 g per dose]); refer to UpToDate text for discussion of alternative agents.