Table 13.
Recommendations/guidelines published by different societies on management of cardiac implantable electronic device infections
| Guidelines content | Recommendations | AHA65 2010 | BHRS19 2015 | ESC59 2015 | AHA199 2015 | HRS81 2017 | EHRA 2019a |
|---|---|---|---|---|---|---|---|
| Diagnosis | |||||||
| Transoesophageal echocardiography | TEE should be used for diagnosis since it has higher sensitivity in establishing intravascular related CIED infection than TTE | ✓ | ✓ | ✓ | ✓ | ✓ | 7 |
| [18F]FDG PET/CT/scintigraphy with radiolabelled WBC | [18F]-FDG PET/CT/scintigraphy with radiolabelled WBC should be used as an additive diagnostic tool | NA | Only for research | ✓ | NA | ✓ | 7 |
| Blood cultures | Blood cultures should be taken 48–72 h after removal of infected CIED | NA | ✓ | NA | NA | NA | 6 |
| Generator pocket tissue/lead | Percutaneous aspiration of generator pocket should not be performed | ✓ | NA | NA | NA | NA | 6 |
| Generator pocket tissue/lead | Tissue should be excised from pocket site and sent for culture | NA | ✓ | NA | NA | NA | 6 |
| Radiography | Chest X-ray should be performed if suspected CIED infection | NA | ✓ | NA | NA | NA | 7 |
| ceCT/CT pulmonary angiography | ceCT or CT pulmonary angiography should be considered when CIED infection is suspected and echocardiography is non-diagnostic | NA | ✓ | NA | NA | NA | 7 |
| Treatment—CIED management | |||||||
| Early post-implantation inflammation | In superficial or early inflammation, the CIED can initially be left in situ. | ✓ | ✓ | NA | NA | NA | 8 |
| Isolated pocket infection/erosion | The CIED must be removed completely within 2 weeks after diagnosis | ✓ | ✓ | NA | NA | NA | 8 |
| CIED lead infection | Complete device system must be removed in CIED lead infection. | ✓ | ✓ | NA | NA | ✓ | 8 |
| CIED infective endocarditis | Complete removal is mandatory in CIED infective endocarditis | ✓ | ✓ | ✓ | ✓ | ✓ | 8 |
| Occult bacteraemia | Complete device removal is recommended in occult bacteraemia | ✓ | NA | NA | NA | ✓ | 8 |
| Device reimplantation | New transvenous lead implant should be postponed if possible, to allow a few days or weeks of antibiotic therapy | ✓ | ✓ | ✓ | NA | ✓ | 10 |
| Device reimplantation | The replacement device implantation should not be ipsilateral to extraction site. Preferred locations are contralateral side, iliac vein, or epicardial | ✓ | ✓ | NA | NA | ✓ | 10 |
| Treatment—antibiotic strategy | |||||||
| Early post-implantation inflammation | In early post-implantation inflammation, the use of antibiotic therapy should be determined on a case by case basis | NA | ✓ | NA | NA | NA | 9 |
| Uncomplicated pocket infection | In uncomplicated pocket infection, empirical antibiotic therapy can be used | NA | ✓ | NA | NA | NA | 9 |
| Complicated pocket infection | Duration of antibiotic therapy should be 10–14 days after CIED removal for pocket-site infection | ✓ | NA | NA | NA | NA | 9 |
| Complicated pocket infection | Antibiotic treatment options and duration depend on echo findings; if no native valve involvement, treat as uncomplicated generator pocket infection | NA | ✓ | NA | NA | NA | 9 |
| CIED lead infection | Duration of antibiotic therapy should be at least 14 days after CIED removal for bloodstream infection | ✓ | NA | NA | NA | NA | 9 |
| CIED infective endocarditis | The duration of antibiotic therapy should be at least 4–6 weeks for complicated infection | ✓ | ✓ | NA | ✓ | NA | 9 |
| Antibiotic prophylaxis | Systemic antibiotic prophylaxis should be used prior to CIED implantation | ✓ | ✓ | NA | NA | NA | 4 |
| Team/reference centre | Complicated infective endocarditis should be referred early and managed in a reference centre with immediate surgical facilities (‘Endocarditis Team’) | NA | NA | ✓ | NA | NA | 7 |
18F-FDG PET/CT, fluorine-18-fludeoxyglucose ([18F]FDG) positron emission tomography-computerized tomography (PET/CT) scanning; CIED, cardiac implantable electronic device; NA, not available; TEE, transoesophageal echocardiography; TTE, transthoracic echocardiography; ✓, agreed recommendation.
a
The number refers to the table for the recommendation in the present document where the particular subject was addressed.