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. 2019 Jul;60(7):998-1002. doi: 10.2967/jnumed.118.221929. Epub 2018 Dec 14.
Current guidelines recommend intravenous antibiotic therapy for at least 4 wk in patients with high-risk bacteremia (SAB), because of the risk for metastatic infection. We evaluated the safety of a shorter duration of treatment in patients with high-risk SAB without signs of metastatic infection at presentation, using standard F-FDG PET/CT and echocardiography. Retrospective analyses were performed of patients with SAB admitted between 2013 and 2017 in 2 medical centers. Patients with risk factors for complicated bacteremia (community acquisition, persistently positive blood cultures, >72 h of fever, or foreign body materials present), a normal echocardiography result, and F-FDG PET/CT without signs of metastatic infection were included (cases) and compared with patients with uncomplicated bacteremia (absence of any of the risk factors and no known metastatic disease, controls). Primary outcomes were 3-mo SAB-specific mortality rate and recurrent infection. The secondary outcome was overall mortality. We included 36 cases and 40 controls. Both groups had a similar treatment duration (15.9 vs. 15.4 d). No deaths occurred as a consequence of SAB in the cases, compared with 1 in the control group. One relapse occurred in the case group and 2 in the control group. Overall mortality did not differ between the groups (19.4% vs. 15.0%, = 0.64). This study suggests that intravenous treatment for 2 wk in high-risk patients with SAB without endocarditis and absence of metastatic infection on F-FDG PET/CT is safe. A diagnostic-driven approach using F-FDG PET/CT to determine treatment duration in high-risk SAB seems feasible and allows tailoring treatment to individual patients.
目前的指南建议高危菌血症（SAB）患者至少静脉用抗生素治疗 4 周，因为存在转移性感染的风险。我们使用标准的 F-FDG PET/CT 和超声心动图评估了在就诊时无转移性感染迹象的高危 SAB 患者缩短治疗时间的安全性。
对 2013 年至 2017 年间在 2 家医疗中心住院的 SAB 患者进行了回顾性分析。入选标准为：具有复杂菌血症危险因素（社区获得性感染、持续阳性血培养、发热超过 72 小时或存在异物材料）、超声心动图结果正常、F-FDG PET/CT 无转移性感染迹象的患者（病例组），并与无并发症菌血症患者（无任何危险因素且无已知转移性疾病，对照组）进行比较。主要结局为 3 个月 SAB 特异性死亡率和再感染率。次要结局为总死亡率。
共纳入 36 例病例和 40 例对照组。两组的治疗持续时间相似（15.9 天 vs. 15.4 天）。在病例组中，无 SAB 导致的死亡，而对照组中有 1 例死亡。病例组有 1 例复发，对照组有 2 例复发。两组总死亡率无差异（19.4% vs. 15.0%， = 0.64）。
这项研究表明，对于无心内膜炎且 F-FDG PET/CT 无转移性感染迹象的高危 SAB 患者，静脉治疗 2 周是安全的。使用 F-FDG PET/CT 进行诊断驱动的方法来确定高危 SAB 的治疗持续时间似乎是可行的，并且可以根据患者个体情况调整治疗方案。
