Generator-pocket tissue Gram stain and culture and lead-tip culture should be obtained when the CIED is explanted. IC 3. Patients with suspected CIED infection who either have positive blood cultures or have negative blood cultures but have had recent antimicrobial therapy before blood cultures were obtained should undergo TEE for CIED infection or valvular endocarditis. IC 4. All adults suspected of having CIED-related endocarditis should undergo TEE to evaluate the left-sided heart valves, even if transthoracic views have demonstrated lead-adherent masses. In pediatric patients with good views, TTE may be sufficient. IB 5. Patients should seek evaluation for CIED infection by cardiologists or infectious disease specialists if they develop fever or bloodstream infection for which there is no initial explanation. IIaC 6. Percutaneous aspiration of the generator pocket should not be performed as part of the diagnostic evaluation of CIED infection. IIIC B. Recommendations for antimicrobial management of CIED infection 1. Choice of antimicrobial therapy should be based on the identification and in vitro susceptibility results of the infecting pathogen. IB 2. Duration of antimicrobial therapy should be 10 to 14 days after CIED removal for pocket-site infection. 1C 3. Duration of antimicrobial therapy should be at least 14 days after CIED removal for bloodstream infection. 4. Duration of antimicrobial therapy should be at least 4 to 6 weeks for complicated infection (ie, endocarditis, septic thrombophlebitis, or osteomyelitis or if bloodstream infection persists despite device removal and appropriate initial antimicrobial therapy). C. Recommendations for removal of infected CIED 1. 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. 