IIaC E. Recommendations for use of long-term suppressive antimicrobial therapy 1. Long-term suppressive therapy should be considered for patients who have CIED infection and who are not candidates for complete device removal. IIbC 2. Long-term suppressive therapy should not be administered to patients who are candidates for infected CIED removal. IIIC (Continued) Baddour et al Cardiovascular Device Infections 471 care of dying patients and device deactivation. In addition, there will be a thorough addressing of the ethics of CIED use in a pending statement on CIED extraction from the Heart Rhythm Society. Removal of Noninfected CIEDs Avoidance of Microbiological Studies Noninfectious device-related complications or device malfunc- tion may occur that requires CIED removal with new device placement. At the time of device removal, specimens from the generator pocket or the explanted device should not be routinely sent for microbiological studies unless there are intraoperative findings to suggest concurrent infection. As evidenced in a previous investigation,69 intraoperative culture specimens fre- quently yield bacteria, although there is no other evidence of infection. In these cases, it is presumed that contamination during device explantation and processing of specimens likely account for the majority of positive cultures. In these cases, no antimicrobial therapy has been administered, and the rate of subsequent device infection has been no greater than expected. Thus, cultures should not be obtained routinely, because if positive, they could be misinterpreted as being clinically signif- icant and lead to the inappropriate administration of antimicro- bials, or worse, removal of the newly implanted device. Recommendations to Avoid Microbiological Studies in Cases of CIED Removal for Noninfectious Reasons Class III 1. Routine microbiological studies should not be con- ducted on CIEDs that have been removed for noninfec- tious reasons. 