Investigations for cardiac implantable electronic device infections

Seek expert advice for diagnosis of cardiac implantable electronic device infection in children.

To assess suspected cardiac implantable electronic device infection in adults, both blood cultures and an echocardiogram are essential. Before starting antibiotic therapy, take 3 sets of blood for culture (from separate venipuncture sites). For advice on obtaining good quality blood samples for culture, see Principles of obtaining blood for culture.

In adults, transthoracic echocardiography (TTE) has low sensitivity but high specificity for the detection of vegetations on cardiac implantable electronic device leads. A negative TTE does not rule out endocarditis on the leads. Transoesophageal echocardiography (TOE) is significantly more sensitive for detecting vegetations and can also provide information about valve infection and dysfunction. If cardiac implantable electronic device lead endocarditis is suspected, TOE is recommended. If the diagnosis or exclusion of cardiac implantable electronic device infection remains unclear following TOE, additional imaging (eg fluorine-18 positron emission tomography/computed tomography [¹⁸F-FDG PET] scanning) may be considered; seek expert adviceAnton-Vazquez, 2022Sag, 2022.