Task Force 4: Inpatient Management of Patients with MCSD - The ...

5. Directed radiographic studies based on presenting symptoms and exam are
recommended.
Level of Evidence: A.
Class IIa:
1. Erythrocyte sedimentation rate or serial C-reactive protein should be considered.
Level of Evidence: C.
Class III:
1. Routine computed tomography of the chest, abdomen and pelvis is not
recommended.
Level of Evidence: C.
Device-specific Infections:
It is often difficult to determine if a device has become infected, but there are a
number of clinical and laboratory criteria by which such a determination can be made.
The consensus statement notes several major and minor criteria that contribute to
making the diagnosis of a device-specific infection. 87 Major criteria include positive
blood cultures with no other site of infection, positive blood cultures from a central
venous catheter, or an echocardiogram positive for infective endocarditis. Minor clinical
criteria include fever, vascular or immunologic phenomenon, or blood cultures that do
not meet the definition for major criteria. The determination of a MCSD infection can be
made using these criteria as shown in Table 3.
Recommendations for Determination of a MCSD-specific Infection:
Class I:
1. A proven MCSD-specific infection is defined as definitive microbiology, histologic
confirmation at MCS explants, or two major clinical criteria.
Level of Evidence: B.
2. A probable MCSD-specific infection is defined as 1 major and 3 minor criteria, or 4
minor criteria.
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