Assess implantation strategies in infants and children for CIED with respect to both leads and generators that will reduce both short- and long-term infection rates. 10. Develop gene and cell therapies to obviate the need for CIED devices. 11. Define the current financial cost of CIED infection in the United States. 12. Determine whether generator capsule excision and pocket closure before new device placement are benefi- cial in reducing the likelihood of new CIED infection. 13. Determine the risk of CIED infection among patients with bloodstream infection due to coagulase-negative staphylococci, streptococci, enterococci, and Candida species and no other evidence of device infection. Summary of Recommendations This document has addressed critical aspects of CIED infec- tions. In particular, management strategies have been presented, and a summary of recommendations is outlined in Table 3. Acknowledgments The authors thank Drs John Bradley, Charles Love, Anne Rowley, and Jon Weinstock for their critical review of the manuscript. Table 3. Continued Recommendation Class and Level of Evidence F. Recommendations for antimicrobial prophylaxis at the time of CIED placement 1. Prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered. If cefazolin is selected for use, then it should be administered intravenously within 1 hour before incision; if vancomycin is given, then it should be administered intravenously within 2 hours before incision. IA G. Recommendations for antimicrobial prophylaxis for invasive procedures in patients with CIEDs 1. Antimicrobial prophylaxis is not recommended for dental or other invasive procedures not directly related to device manipulation to prevent CIED infection. IIIC H. Recommendations to avoid microbiological studies in cases of CIED removal for noninfectious reasons 1. Routine microbiological studies should not be conducted on CIEDs that have been removed for noninfectious reasons. IIIB TTE indicates transthoracic echocardiography. 