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CIED Infection Management — EECC MCQ

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ModerateCardiac DevicesCIED Infection ManagementEECC

A 62-year-old man with a cardiac implantable electronic device (CIED) develops pocket erythema, wound dehiscence, and fever. Blood cultures grow coagulase-negative Staphylococcus. What is the recommended management?

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Correct answer: A — Complete device and lead extraction with prolonged IV antibiotic therapy; reimplantation at a different site after blood cultures are negative

CIED infection (including pocket infection and lead-related endocarditis) requires complete system extraction (generator AND all leads). The ESC IE Guidelines and BHRS guidelines recommend: (1) complete device and lead extraction (percutaneous or surgical); (2) prolonged IV antibiotic therapy (at least 2 weeks for pocket infection, 4-6 weeks for lead-related endocarditis); (3) negative blood cultures for ≥72 hours before reimplantation; (4) reimplantation at a contralateral site. Partial extraction (generator only) or conservative management with antibiotics alone is associated with high failure rates and recurrent infection. Lead extraction should be performed at experienced centres due to procedural risks (vascular injury, cardiac perforation).

Reference: ESC (2023): Guidelines on Infective Endocarditis; BHRS CIED Infection Guidelines