General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain.
Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain.
Infection. 2017 Oct;45(5):691-696. doi: 10.1007/s15010-017-0992-5. Epub 2017 Feb 27.
The role of F-fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia.
We report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management.
All patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli.
F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.
虽然一些作者已经报道 F-氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（F-FDG PET/CT）在成人转移性病灶筛查中具有一定的益处，但 F-FDG PET/CT 在儿童导管相关性血流感染的转移性感染灶诊断中的作用仍鲜有研究。感染性肺栓子是最难识别的栓子之一，因为许多情况下患者并无肺部症状或异常的胸部 X 线表现。然而，这些病灶的诊断具有重要的治疗意义。本文旨在描述 F-FDG PET/CT 在金黄色葡萄球菌导管相关性菌血症患儿感染性肺栓子诊断中的作用。
我们报告了 3 例金黄色葡萄球菌导管相关性菌血症且入院时胸部 X 线正常的患儿，F-FDG PET/CT 对这 3 例患儿均提示存在未被怀疑的感染性肺栓子，这对临床管理具有重要影响。
所有患儿均患有血友病和植入式静脉输液港，表现为发热和正常的肺部听诊。仅有 1 例患儿报告了非特异性症状（左侧胸部不明原因疼痛）。所有患儿入院时胸部 X 线均正常。2 例患儿在入院后 48 小时内拔除了导管，最后 1 例患儿在入院后 5 天内拔除了导管，发热消退。2 例患儿的配对血培养均未能确定菌血症。然而，在所有病例中，导管尖端和皮下输液港培养均分离出金黄色葡萄球菌，且 F-FDG PET/CT 发现了未被怀疑的肺部转移性栓子。
F-FDG PET/CT 应被视为一种有用的工具，可用于诊断金黄色葡萄球菌导管相关性菌血症中的感染性肺栓子，尤其是在常规诊断影像学技术未能发现可能的转移性病灶时。需要进一步研究来阐明 F-FDG PET/CT 在儿童导管相关性血流感染中的应用价值。
