At least 2 weeks of parenteral therapy is recommended after extraction of an infected device for patients with bloodstream infection. Patients with sustained ( 24 hours) positive blood cultures despite CIED removal and appropriate antimicrobial therapy should receive parenteral therapy for at least 4 weeks, even if TEE is negative for valvular vegetations. It is intuitive that adequate debridement and control of infection at all sites, both at the generator site and metastatic, if present, be achieved before new device placement. The con- tralateral side is preferred for new device placement, if required. There are several aspects of CIED removal for which data are needed so that management recommendations can be provided. These include whether the infected pocket site should be closed before new device placement, whether generator-capsule debridement is appropriate, and how to manage patients who have undergone device removal but have a remaining lead remnant. Patients with bloodstream infection and no localizing evi- dence of either generator-site infection or lead or endocardial involvement represent a difficult management group. Although bloodstream infection can be a manifestation of CIED infection, it can occur without CIED infection. There are several clinical parameters26,75 that may better characterize patients who have CIED infection and S aureus bacteremia but no localizing evidence of infection. These include the following: (1) Relapsing bacteremia after a course of appropriate antibiotic therapy; (2) if there is no other identified source for bacteremia; (3) if bacte- remia persists more than 24 hours; (4) if the CIED is an ICD; (5) presence of a prosthetic cardiac valve; and (6) bacteremia within 3 months of device placement. On the basis of findings from 1 investigation,27 CIED infection is unlikely in patients with Gram-negative bactere- mia and no other evidence of device infection; thus, CIED removal is not recommended in this setting. 