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CIED Endocarditis — RACP Adult Medicine MCQ

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HardCardiologyCIED EndocarditisRACP Adult Medicine

A 62-year-old man with a permanent pacemaker for complete heart block presents with fever, rigors, and positive blood cultures for Staphylococcus aureus (MSSA). Transoesophageal echocardiography shows a vegetation on the pacemaker lead. What is the definitive management?

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Correct answer: D — IV flucloxacillin plus lead extraction

Cardiac device-related infective endocarditis requires complete device extraction (leads and generator) combined with prolonged IV antibiotics (flucloxacillin for MSSA for ≥4–6 weeks). Antibiotic therapy alone without lead extraction has unacceptably high relapse rates (>50%). Lead extraction can be performed percutaneously (laser or mechanical extraction) or surgically. A new device can be reimplanted on the contralateral side after blood cultures are negative for ≥72 hours.

Reference: eTG – 2025 – Antibiotic Guidelines; ESC – 2023 – IE Guidelines; HRS – 2017 – CIED Infection Guidelines