Enterobacter cloacae Infection of a Cardiovascular Implantable Electronic Device (CIED): A Rare Cause of Device-Related Infection

Cardiac implantable electronic device (CIED) infections are uncommon but serious complications that can be difficult to diagnose, especially in the absence of echocardiographic findings. As CIED utilization increases, so does the risk of infection, underscoring the importance of early recognition and timely management. We describe a case of <i>Enterobacter cloacae</i> (<i>E. cloacae</i>) CIED infection, a rarely reported cause of device-related infection, presenting as persistent bacteremia despite susceptibility-guided antibiotic therapy. Repeated echocardiography and advanced imaging failed to localize the source, and management was complicated by inducible AmpC β-lactamase resistance, requiring escalation to carbapenem therapy. The diagnosis was ultimately confirmed by culture of the extracted pacemaker lead tip, with clinical resolution following device removal. This case highlights the diagnostic and therapeutic challenges posed by atypical <i>E. cloacae</i> CIED infections, including imaging limitations and antimicrobial resistance. It emphasizes the value of device-led culture and timely removal in achieving successful outcomes.