Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
BMC Infect Dis. 2022 Mar 24;22(1):282. doi: 10.1186/s12879-022-07273-x.
[18F]FDG-PET/CT is used for diagnosing metastatic infections in Staphylococcus aureus bacteremia (SAB) and guidance of antibiotic treatment. The impact of [18F]FDG-PET/CT on outcomes remains to be determined. The aim of this systematic review was to summarize the effects of [18F]FDG-PET/CT on all-cause mortality and new diagnostic findingsin SAB.
We systematically searched PubMed, EMBASE.com, Web of Science, and Wiley's Cochrane library from inception to 29 January 2021. Eligible studies were randomized controlled trials, clinically controlled trials, prospective and retrospective cohort studies, and case-control studies investigating the effects of [18F]FDG-PET/CT in hospitalized adult patients with SAB. We excluded studies lacking a control group without [18F]FDG-PET/CT. Risk of bias was assessed using the ROBINS-I tool and certainty of evidence using the GRADE approach by two independent reviewers.
We identified 1956 studies, of which five were included in our qualitative synthesis, including a total of 880 SAB patients. All studies were non-randomized and at moderate or serious risk of bias. Four studies, including a total of 804 patients, reported lower mortality in SAB patients that underwent [18F]FDG-PET/CT. One study including 102 patients reported more detected metastatic foci in the participants in whom [18F]FDG-PET/CT was performed.
We found low certainty of evidence that [18F]FDG-PET/CT reduces mortality in patients with SAB. This effect is possibly explained by a higher frequency of findings guiding optimal antibiotic treatment and source control interventions.
[18F]FDG-PET/CT 用于诊断金黄色葡萄球菌菌血症（SAB）中的转移性感染，并指导抗生素治疗。[18F]FDG-PET/CT 对结局的影响仍有待确定。本系统评价的目的是总结[18F]FDG-PET/CT 对 SAB 患者全因死亡率和新诊断发现的影响。
我们系统地检索了 PubMed、EMBASE.com、Web of Science 和 Wiley 的 Cochrane 图书馆，检索时间从建库到 2021 年 1 月 29 日。合格的研究是随机对照试验、临床对照试验、前瞻性和回顾性队列研究以及病例对照研究，调查了 [18F]FDG-PET/CT 对住院成人 SAB 患者的影响。我们排除了缺乏无 [18F]FDG-PET/CT 对照组的研究。两位独立评审员使用 ROBINS-I 工具评估偏倚风险，使用 GRADE 方法评估证据确定性。
我们共确定了 1956 项研究，其中 5 项研究纳入了我们的定性综合分析，共纳入 880 例 SAB 患者。所有研究均为非随机，偏倚风险为中度或高度。四项研究（共 804 例患者）报告称，接受 [18F]FDG-PET/CT 检查的 SAB 患者死亡率较低。一项研究（共 102 例患者）报告称，在接受 [18F]FDG-PET/CT 检查的患者中，更多地检测到转移性病灶。
我们发现证据确定性低，[18F]FDG-PET/CT 可降低 SAB 患者的死亡率。这种效果可能是由于发现指导最佳抗生素治疗和源控制干预的频率更高。
