**8. Diagnosis**

 The signs and symptoms of CIED infection depend on the location of the infected part of the device, but establishing the diagnosis can sometimes be challenging with a variety of manifestations. Fever is present in most cases. It is reasonable to always consider device infection for patients with CIEDs and unexplained fever, keeping in mind that a blunted fever response is common among the elderly [5]. In some cases, with typical symptoms of localized generator pocket infection, diagnosing CIED infection is simple. In other cases, the symptoms can be extremely vague despite extensive infection, often resulting in diagnostic delays. As with other types of endocarditis, diagnosis is not built on a single test, but rather evaluation of a pattern of signs and investigations where echocardiography and blood cultures play a fundamental role. Sometimes, *S. aureus* bacteremia can be the only sign of device infection [5]. A central recommendation in guidelines is also that the patient with suspected CIED infection should be evaluated by a multidisciplinary team [14].
