Continuous, in situ–targeted, ultrahigh-concentration antibiotic therapy for high-risk cardiovascular implantable electronic device infection: A rural tertiary care experience

The use of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter-defibrillators (ICDs), has increased significantly in recent years. CIED-related infections are serious complications, occurring in up to 25% of patients undergoing two or more device replacements [1,2]. Even localized pocket infections warrant complete device system extraction per guideline recommendations. Although the overall procedural risk of CIED extraction is low (1–2%), certain patient and device characteristics—such as prolonged lead dwell time, ICD leads, and multiple comorbidities—can significantly increase procedural complexity and risk [3].