[CK] PM infection. infected pacemaker [ ] read

Approach to evaluation and management of suspected cardiac implantable electronic device (CIED) infection in adults

TEE: transesophageal echocardiogram.
* We favor initial therapy with vancomycin (15 to 20 mg/kg/dose intravenously every 8 to 12 hours [not to exceed 2 g per dose]); in patients presenting with severe sepsis, broadening of parenteral therapy to include gram-negative bacteria is appropriate. Refer to the UpToDate text for further discussion.
¶ Blood cultures may be rendered falsely negative by prior antimicrobial therapy.
Δ Refer to the UpToDate text for discussion of management for Candida infection.
◊ High-grade bacteremia is defined as more than one positive culture.
§ The choice of antibiotic regimen is guided by blood culture results (refer to UpToDate text). The duration of antibiotic therapy should be counted from the day of device explantation, if warranted.

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Approach to evaluation and management of suspected infection limited to cardiac implantable electronic device (CIED) pocket in adults

TEE: transesophageal echocardiogram; MRSA: methicillin-resistant Staphylococcus aureus.
* Refer to separate UpToDate algorithm for approach to patients with systemic symptoms, positive blood cultures, and/or vegetation on TEE.
¶ Oral antibiotic dosing as follows:

• Cephalexin 500 mg orally four times daily
• Clindamycin 300 to 450 mg orally four times daily (use higher dose for patients with weight >120 kg)
• Dicloxacillin 500 mg orally four times daily
• Doxycycline 100 mg orally twice daily
• Minocycline 200 mg orally once, then 100 mg orally every 12 hours
• Trimethoprim-sulfamethoxazole 1 to 2 double-strength tablets orally every 12 hours

Δ We favor initial therapy with vancomycin (15 to 20 mg/kg/dose intravenously every 8 to 12 hours [not to exceed 2 g per dose]); refer to the UpToDate text for discussion of alternative agents.

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