treat ICD infection as endocarditis

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:

  • Evidence of valve or lead vegetation on transesophageal echocardiogram (TEE)
  • Positive blood cultures with an organism with high propensity for causing infective endocarditis (eg, Staphylococcus, Streptococcus, or Candida spp)
  • Evidence of pocket infection, including localized pain/tenderness, erythema, swelling, purulent drainage, or skin erosion

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.