Complete device and lead removal is recommended for all patients with definite CIED infection, as evidenced by valvular and/or lead endocarditis or sepsis. IA 2. Complete device and lead removal is recommended for all patients with CIEM pocket infection, as evidenced by abscess formation, device erosion, skin adherence, or chronic draining sinus without clinically evident involvement of the transvenous portion of the lead system. 3. Complete device and lead removal is recommended for all patients with valvular endocarditis without definite involvement of the lead(s) and/or device. 4. Complete device and lead removal is recommended for patients with occult staphylococcal bacteremia. 5. Complete device and lead removal is reasonable in patients with persistent occult Gram-negative bacteremia despite appropriate antibiotic therapy. IIaB 6. CIED removal is not indicated for a superficial or incisional infection without involvement of the device and/or leads. IIIC 7. CIED removal is not indicated for relapsing bloodstream infection due to a source other than a CIED and for which long-term suppressive antimicrobials are required. IIIC D. Recommendations for new CIED implantation after removal of an infected CIED 1. Each patient should be evaluated carefully to determine whether there is a continued need for a new CIED. IC 2. The replacement device implantation should not be ipsilateral to the extraction site. Preferred alternative locations include the contralateral side, the iliac vein, and epicardial implantation. 3. When positive before extraction, blood cultures should be drawn after device removal and should be negative for at least 72 hours before new device placement is performed. IIaC 4. New transvenous lead placement should be delayed for at least 14 days after CIED system removal when there is evidence of valvular infection. IIaC E. Recommendations for use of long-term suppressive antimicrobial therapy 1. 