Bacteraemia where cardiac implantable electronic device infection is suspected but not proven
For patients with a cardiac implantable electronic device and bacteraemia, even if investigations indicate that the device is not infected, closely monitor the patient for signs of cardiac implantable electronic device infection or relapse of bacteraemia.
Up to 45% of patients with a cardiac implantable electronic device and Staphylococcus aureus bacteraemia have an underlying device infection, as do approximately 30% of patients with other gram-positive bacteraemias (including enterococcal species)Garrigos, 2019Oh, 2019. Cardiac implantable electronic device infection is much less common in patients with gram-negative bacteraemia.
For patients with a cardiac implantable electronic device and a single positive S. aureus blood culture result, consider cardiac implantable electronic device infection – manage as for lead endocarditis. For patients with bacteraemia due to other organisms, consider cardiac implantable electronic device infection if positive blood culture results persist despite appropriate antibiotic therapy – manage as for lead endocarditis.
In general, for patients with gram-negative bacteraemia who do not have vegetations on transoesophageal echocardiogram and have an alternative site of infection (eg urinary tract), treat the bacteraemia as for the likely source. Monitor closely for recurrent or persistent infection. If bacteraemia recurs, consider cardiac implantable electronic device infection and the likely need for device removal.