Cardiovascular Implantable Electronic Device Infections

Publication Date: December 4, 2023
Last Updated: December 6, 2023

Prevention

Prevention Overview

  • Hematoma formation, regardless of size, is associ-ated with a high risk of CIEDI; thus, prevention is critical.
  • Continued or interrupted DOAC at the time of CIED implantation/revision are both acceptable because both are associated with a low risk of hematoma formation.
  • In patients receiving warfarin, it is reasonable to perform CIED implantation with a therapeutic international normalized ratio between 2 and 3.5.

Diagnosis

Diagnosis Overview

  • Physical examination changes at the genera-tor pocket, such as fluctuance, purulent drainage, device erosion through skin, or sinus tract forma-tion, are considered definite pocket infection.
  • Patients with persistent S aureus or coagulase-negative staphylococcal bloodstream infection are at high risk of CIEDI and therefore should undergo timely device removal and antimicrobial therapy.
  • Persistent bloodstream infection despite appropri-ate antimicrobial therapy due to nonstaphylococcal organisms raises concern for CIEDI, and treatment for such with complete device removal and contin-ued antimicrobial therapy is reasonable if no alter-native source of infection is established.

Overview

Title

Cardiovascular Implantable Electronic Device Infections

Authoring Organization