Page 60 - HPP ANTIMICROBIAL GUIDELINE 2018

B. CIED (CARDIAC IMPLANTABLE EXTERNAL DEVICE) INFECTION

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Empirical treatment Cloxacillin 2gm q4-6h Removal of CIED is the recommended treatment

Duration of therapy: Blood cultures should be drawn after device removal
and should be negative for at least 72 hours before
7 to 14 days (after CIED removal) new device placement is performed

4- 6 weeks (if endocarditis) Long-term suppressive therapy should be considered
for patients who have CIED infection and who are not
candidates for complete device removal

C. MEDIASTINITIS POST CARDIAC SURGERY

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Mediastinitis Cloxacillin 2gm IV q4-6h Vancomycin 15- 20mg/kg IV The duration of therapy generally
q8h- q12h, not to exceed 2g/dose ranges from 2-6 weeks and depends
on the extend of surgical
PLUS PLUS debridement performed.
Piperacillin/tazobactam 4.5gm IV q6h Piperacillin/tazobactam 4.5gm IV q6h
If osteomyelitis treats for 4- 6 weeks

References:
1. Updates on Cardiovascular Implantable Electronic Device Infections and Their Management (A AHA scientific meeting from the American Heart
Association)- 2010
2. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare
Professionals from the American Heart Association 2015
3. Clinical practice guidelines for the prevention, diagnosis & management of infective endocarditis

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