Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Indgang 44, 46, 5000, Odense C, Denmark.
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark.
Eur J Nucl Med Mol Imaging. 2019 Jun;46(6):1351-1358. doi: 10.1007/s00259-019-04289-5. Epub 2019 Feb 20.
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.
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).
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.
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.
FDG-PET/CT appears clinically useful in BUOCSA. Prospective studies are warranted for confirmation.
菌血症与高死亡率相关，尤其是当感染部位未知时。虽然常规影像学通常集中于特定的身体部位，但 FDG-PET/CT 可可视化全身代谢活跃的焦点。
研究 FDG/PET-CT 检测感染部位的能力及其在不明来源菌血症中对 catalase-negative Gram-positive cocci（不包括肺炎球菌和肠球菌）或金黄色葡萄球菌（BUOCSA）的临床影响。
我们回顾性地确定了 157 例 165 例 BUOCSA 患者，随后对其进行了 FDG-PET/CT 检查。数据来自病历。菌血症患者重要感染部位的决策基于整个患者病程，并作为参考诊断与 FDG-PET/CT 结果进行比较。如果 FDG-PET/CT 正确揭示了其他影像学检查未评估的感染部位，或者在这些部位其他影像学检查为阴性/不确定，如果它确定了新的临床相关诊断，和/或导致抗菌治疗的改变，则认为 FDG-PET/CT 具有高临床影响。
FDG-PET/CT 在 56.4%的病例中检测到感染部位，在 47.3%的病例中有高临床影响。它是在 41.1%的菌血症病例中首先识别感染部位的第一种影像学检查方式，导致抗菌治疗改变的占 14.7%，并建立了与菌血症无关的新诊断的占 9.8%。FDG-PET/CT 检测率和临床影响不受抗菌治疗前的时间、从怀疑菌血症到 FDG-PET/CT 扫描的天数、菌血症的类型或癌症的影响。
FDG-PET/CT 在 BUOCSA 中具有临床应用价值。需要前瞻性研究来证实。
