What is the recommended duration of antimicrobial therapy for CIED infections?
There are no clinical trial data to define the optimal duration of antimicrobial therapy for CIED infections, regardless of the extent of infection, or to determine when conversion to an oral agent is appropriate once complete device removal has been achieved. Factors that influence medical decision making include the extent of device infection, the causative organism, the presence and duration of bloodstream infection, and associated complications such as valvular involvement, septic thrombophlebitis, or osteomyelitis. When CIED infection is limited to the pocket site, 7 to 10 days of therapy after device removal is reasonable if the presentation is device erosion without inflammatory changes; otherwise, 10 to 14 days of antimicrobial treatment is recommended. At least 2 weeks of parenteral therapy is recommended after extraction of an infected device for patients with bloodstream infection.