Bridging the Gap: From Early Recognition to Timely Referral for Cardiac Implantable Electronic Devices Infections

An increasing number of patients are living with cardiac implantable electronic devices (CIEDs). When a patient with a CIED is hospitalized with concern for infection or positive blood cultures from any source, recognizing and managing a possible CIED infection is critical due to its significant morbidity and mortality risk. Internists are often the first to evaluate these patients and must consider the possibility of an underlying device infection. Gram-positive bacteremia carries a high risk of CIED infection, often necessitating cardiac imaging. In contrast, hematogenous seeding with gram-negative bacteremia is infrequent. Patients with clinical or imaging evidence of device infection should be promptly referred to an extraction center for possible removal. Delayed removal of infected devices in patients with systemic signs increases the risk of death. We propose a simplified approach to evaluating for CIED infection and prompt referral for extraction when indicated. A multidisciplinary team-including hospitalists, infectious diseases specialists, electrophysiologists, and cardiac imaging experts-is essential to optimize the management and outcomes of these complex infections.