Complete device and lead removal is recommended for patients with occult staphylococcal bacteremia. (Level of Evidence: B) Class IIa 1. Complete device and lead removal is reasonable in patients with persistent occult Gram-negative bactere- mia despite appropriate antibiotic therapy. (Level of Evidence: B) Class III 1. CIED removal is not indicated for a superficial or incisional infection without involvement of the device and/or leads. (Level of Evidence: C) 2. CIED removal is not indicated for relapsing blood- stream infection due to a source other than a CIED and for which long-term suppressive antimicrobials are required. (Level of Evidence: C) New Device Implantation It is imperative that there be an assessment of the need for new device placement in each patient with an infected CIED. One third to one half of patients in some series will not require new CIED placement.38 There are several factors, including reversal of the pathological processes that precipi- tated the need for CIED implantation, changing clinical circumstances, and lack of appropriate clinical indication initially, that obviate the need for new CIED placement and thus result in avoidance of new device infection. Removal of infected hardware should not be attempted until a careful assessment of a new implantation strategy has been performed, particularly in patients with pacemakers for complete heart block and resynchronization therapy devices. When implantation of a new device is necessary, it should be performed on the contralateral side if possible to avoid relapsing device infection. If this is not possible, a trans- venous lead can be tunneled to a device placed subcutane- ously in the abdomen. Implantation is usually postponed to allow for resolution of infection, but patients who are PPM dependent represent a challenge, because they cannot be discharged home with a temporary pacemaker. 