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Eur J Nucl Med Mol Imaging. 2019 Jun;46(6):1351-1358. doi: 10.1007/s00259-019-04289-5. Epub 2019 Feb 20.

Clinical value of FDG-PET/CT in bacteremia of unknown origin with catalase-negative gram-positive cocci or Staphylococcus aureus.

Author information

1
Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Indgang 44, 46, 5000, Odense C, Denmark. mette@taulov-data.dk.
2
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark. mette@taulov-data.dk.
3
Department of Rheumatology, Odense University Hospital, Kløvervænget 5, Indgang 132 1, 5000, Odense C, Denmark. mette@taulov-data.dk.
4
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark.
5
Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, 5000, Odense C, Denmark.
6
Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 2, 5000, Odense C, Denmark.
7
Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Indgang 44, 46, 5000, Odense C, Denmark.
8
Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
9
Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark.

Abstract

INTRODUCTION:

Bacteremia is associated with high mortality, especially when the site of infection is unknown. While conventional imaging usually focus on specific body parts, FDG-PET/CT visualizes hypermetabolic foci throughout the body.

PURPOSE:

To investigate the ability of FDG/PET-CT to detect the site of infection and its clinical impact in bacteremia of unknown origin with catalase-negative Gram-positive cocci (excluding pneumococci and enterococci) or Staphylococcus aureus (BUOCSA).

METHODS:

We retrospectively identified 157 patients with 165 episodes of BUOCSA, who subsequently underwent FDG-PET/CT. Data were collected from medical records. Decision regarding important sites of infection in patients with bacteremia was based on the entire patient course and served as reference diagnosis for comparison with FDG-PET/CT findings. FDG-PET/CT was considered to have high clinical impact if it correctly revealed site(s) of infection in areas not assessed by other imaging modalities or if other imaging modalities were negative/equivocal in these areas, or if it established a new clinically relevant diagnosis, and/or led to change in antimicrobial treatment.

RESULTS:

FDG-PET/CT detected sites of infection in 56.4% of cases and had high clinical impact in 47.3%. It was the first imaging modality to identify sites of infection in 41.1% bacteremia cases, led to change of antimicrobial therapy in 14.7%, and established a new diagnosis unrelated to bacteremia in 9.8%. Detection rate and clinical impact were not significantly influenced by duration of antimicrobial treatment preceding FDG-PET/CT, days from suspicion of bacteremia to FDG-PET/CT-scan, type of bacteremia, or cancer.

CONCLUSION:

FDG-PET/CT appears clinically useful in BUOCSA. Prospective studies are warranted for confirmation.

KEYWORDS:

Bacteremia; FDG; Humans; Nuclear medicine; Positron emission tomography

PMID:
30788532
DOI:
10.1007/s00259-019-04289-5

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