Infection of a cardiovascular implantable electronic device (CIED) (ie, pacemaker, implantable cardioverter-defibrillator) has become common due to the increased frequency of device placement. Appropriate management of a known or suspected CIED infection involves removal of the entire device (generator and leads) if any of the following are present:
In patients with suspected endocardial involvement (such as this patient with pain, swelling, and purulent drainage), device removal should be followed by appropriate antibiotic treatment for infective endocarditis (eg, 6 weeks of therapy). Patients with CIED pocket infection but no evidence of endocardial involvement (eg, those with negative blood cultures and unremarkable TEE) can receive 2 weeks of antibiotic therapy following device removal. When needed, reimplantation of a new CIED is performed on the contralateral side of the chest once appropriate source control of the infection is achieved.