A. Principles of treatment
B. Mode of device removal
C. Reimplantation
A. PRINCIPLES OF TREATMENT:
Prolonged antibiotic therapy and device removal are recommended in definite CDRIE. |
| Class |
Level |
| I |
B |
| A. Device removal should be considered when CDRIE is suspected on the basis of occult infection without other apparent source of infection. |
| Class |
Level |
| IIa |
C |
| A. In patients with native or prosthetic valve IE and an intracardiac device with no evidence of associated device infection, device extraction must be considered. |
| Class |
Level |
| IIb |
C |
B. MODE OF DEVICE REMOVAL:
Percutaneous extraction is recommended in most patients with CDRIE even those with large (>10 mm) vegetations. |
| Class |
Level |
| I |
B |
| B. Surgical extraction shoud be considered if percutaneous extraction is incomplete or impossible or when severe destructive tricuspid IE is associated. |
| Class |
Level |
| IIa |
C |
| B. Surgical extraction may be considered in patients with very large (>25 mm) vegetations. |
| Class |
Level |
| IIb |
C |
C. REIMPLANTATION:
After device extraction, reassessment of the need for reimplantation is recommended. |
| Class |
Level |
| I |
B |
| C. When indicated, reimplantation should be postponed if possible to allow a few days or weeks of antibiotic therapy. |
| Class |
Level |
| IIa |
B |
| C. Temporary pacing is not recommended. |
| Class |
Level |
| III |
C |