New transvenous lead placement should be delayed for at least 14 days after CIED system removal when there is evidence of valvular infection. (Level of Evidence: C) Long-Term Suppressive Antimicrobial Therapy Long-term antimicrobial suppressive therapy is used in selected patients with CIED infections who, for a variety of reasons, are not candidates for device removal either by percutaneous or surgical methods.81 Often, these patients have a limited life expectancy or refuse device removal. Long-term suppressive therapy can be attempted in these cases if they meet several criteria, which include a stable cardiovascular status, clinical improvement with initial antimicrobial therapy, and clearance of bloodstream infection. Because there are no comparative trials, the optimal choice of antimicrobial therapy and its dosing are undefined. Moreover, treatment options are frequently limited, because many CIED infections are caused by multidrug-resistant pathogens that are acquired in the healthcare or nosocomial environment. Thus, prolonged suppression of infection can be difficult to achieve with oral antimicrobial therapy. Little is known about CIED infection relapse rates despite use of long-term suppressive therapy. Other factors that are relevant to the use of long-term suppressive therapy include the likelihood for selection of resistant organisms, both for the identified pathogen being suppressed and for normal colonizing strains; safety profile; patient compliance; and financial expense. Recommendations for Use of Long-Term Suppressive Antimicrobial Therapy Class IIb 1. Long-term suppressive therapy should be considered for patients who have CIED infection and who are not candidates for complete device removal. (Level of Evidence: C) Class III 1. Long-term suppressive therapy should not be adminis- tered to patients who are candidates for infected CIED removal. (Level of Evidence: C) Complications of Device Infection Complications of CIED infection can be either contiguous to the device or anatomically remote. 