Berrevoets Marvin A H, Kouijzer Ilse J E, Aarntzen Erik H J G, Janssen Marcel J R, De Geus-Oei Lioe-Fee, Wertheim Heiman F L, Kullberg Bart-Jan, Oever Jaap Ten, Oyen Wim J G, Bleeker-Rovers Chantal P
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
J Nucl Med. 2017 Sep;58(9):1504-1510. doi: 10.2967/jnumed.117.191981. Epub 2017 Mar 23.
Metastatic infection is an important complication of bacteremia (SAB). Early diagnosis of metastatic infection is crucial, because specific treatment is required. However, metastatic infection can be asymptomatic and difficult to detect. In this study, we investigated the role of F-FDG PET/CT in patients with SAB for detection of metastatic infection and its consequences for treatment and outcome. All patients with SAB at Radboud University Medical Center were included between January 2013 and April 2016. Clinical data and results of F-FDG PET/CT and other imaging techniques, including echocardiography, were collected. Primary outcomes were newly diagnosed metastatic infection by F-FDG PET/CT, subsequent treatment modifications, and patient outcome. A total of 184 patients were included, and F-FDG PET/CT was performed in 105 patients, of whom 99 had a high-risk bacteremia. F-FDG PET/CT detected metastatic infectious foci in 73.7% of these high-risk patients. In 71.2% of patients with metastatic infection, no signs and symptoms suggesting metastatic complications were present before F-FDG PET/CT was performed. F-FDG PET/CT led to a total of 104 treatment modifications in 74 patients. Three-month mortality was higher in high-risk bacteremia patients without F-FDG PET/CT performed than in those in whom F-FDG PET/CT was performed (32.7% vs. 12.4%, = 0.003). In multivariate analysis, F-FDG PET/CT was the only factor independently associated with reduced mortality ( = 0.005; odds ratio, 0.204; 95% confidence interval, 0.066-0.624). A higher comorbidity score was independently associated with increased mortality ( = 0.003; odds ratio, 1.254; 95% confidence interval, 1.078-1.457). F-FDG PET/CT is a valuable technique for early detection of metastatic infectious foci, often leading to treatment modification. Performing F-FDG PET/CT is associated with significantly reduced 3-mo mortality.
转移性感染是菌血症（SAB）的一种重要并发症。转移性感染的早期诊断至关重要，因为需要进行针对性治疗。然而，转移性感染可能没有症状且难以检测。在本研究中，我们调查了F-FDG PET/CT在SAB患者中对转移性感染的检测作用及其对治疗和预后的影响。2013年1月至2016年4月期间，纳入了拉德堡德大学医学中心的所有SAB患者。收集了临床数据以及F-FDG PET/CT和其他成像技术（包括超声心动图）的结果。主要结局为通过F-FDG PET/CT新诊断的转移性感染、随后的治疗调整以及患者预后。总共纳入了184例患者，其中105例患者进行了F-FDG PET/CT检查，其中99例患有高危菌血症。F-FDG PET/CT在这些高危患者中检测到转移性感染灶的比例为73.7%。在71.2%的转移性感染患者中，在进行F-FDG PET/CT检查之前没有提示转移性并发症的体征和症状。F-FDG PET/CT共导致74例患者进行了104次治疗调整。未进行F-FDG PET/CT检查的高危菌血症患者的3个月死亡率高于进行了该检查的患者（32.7%对12.4%，P = 0.003）。在多变量分析中，F-FDG PET/CT是唯一与死亡率降低独立相关的因素（P = 0.005；比值比，0.204；95%置信区间，0.066 - 0.624）。较高的合并症评分与死亡率增加独立相关（P = 0.003；比值比，1.254；95%置信区间，1.078 - 1.457）。F-FDG PET/CT是早期检测转移性感染灶的一项有价值的技术，常常会导致治疗调整。进行F-FDG PET/CT检查与3个月死亡率显著降低相关。
