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What is your approach to management of CIED in a patient with community-acquired Staph aureus bacteremia who clears blood cultures quickly with negative follow up blood cultures within 72 hours of antimicrobial therapy and negative TEE?
Would you still routinely ask for CIED removal, or would you pursue PET/CT for further evaluation and consider keeping CIED if PET/CT negative?
Answer from: at Academic Institution
The recent 2023 guidelines on AHS CIEDI defined definite CIED infection as 2 or more sets of blood cultures positive for staph aureus or CoNS + (positive TEE and/Or positive PET/CT). The guidelines stated that the organism isolated from blood cultures determines the likelihood of CIEDI, and coagulas...
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Answer from: at Academic Institution
This is, unfortunately, a not uncommon scenario in clinical practice for which we don't have great data. It is very difficult to convince a cardiologist to take out a CIED with negative repeat blood cultures and negative TEE. PET-CT is often not available. If this is the first episode, the blood cle...
Answer from: at Academic Institution
Sometimes these things cannot come out for various patient-related reasons. When they cannot come out, I leave the patient on a suppressive regimen and monitor him/her.
Answer from: at Community Practice
This often depends on the institution and its available resources. I work at a university hospital that has the capability to remove cardiac implantable electronic devices (CIEDs) and perform inpatient PET scans. Please keep this in mind as context for my response. In these situations, I routinely d...