Heart Failure with Reduced Ejection Fraction — EECC MCQ
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Correct answer: C — Remove the entire generator and transvenous lead system
The best answer is “Remove the entire generator and transvenous lead system”. Hardware exposure is definite device infection even without bacteraemia; biofilm cannot be eradicated reliably while any connected system remains in place. “Close the skin over the exposed generator and give oral antibiotics” is less appropriate because wound closure retains infected prosthetic material “Remove principally the generator and leave all leads in place” is less appropriate because retained leads can sustain biofilm and relapse “Observe because negative blood cultures exclude device infection” is less appropriate because negative blood cultures do not negate local pocket infection “Apply topical antiseptic while continuing to use the system” is less appropriate because topical treatment cannot sterilise exposed implanted hardware
Reference: 2023 ESC Guidelines for infective endocarditis. https://academic.oup.com/eurheartj/article/44/39/3948/7243107