Fighting the invisible enemy

  • Khaldoun G. Tarakji
    Address reprint requests and correspondence: Dr Khaldoun G. Tarakji, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland, OH 44195.
    Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Published:January 27, 2021DOI:
      “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.” This is what the Chinese military strategist Sun Tzu described in “The Art of War” back in the fifth century BC. Our medical practice is always guided by the principle of doing no harm, and our interventions are based on careful assessment of their risks and benefits. This is not hard to accomplish when the diagnosis is clear, and we have the ability to predict the outcomes and understand the natural history of a disease process. But in the case of staphylococcal bacteremia in patients with cardiac implantable electronic devices (CIEDs) in the absence of clear pocket infection or imaging data to support the diagnosis of CIED-related endocarditis, we occasionally find ourselves making significant decisions without the level of confidence we aspire to reach.
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