Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
Infection. 2023 Jun;51(3):743-747. doi: 10.1007/s15010-022-01913-9. Epub 2022 Sep 8.
To assess the likelihood of occult infection in patients with clinically unsuspected orthopedic implants during Staphylococcus aureus bacteremia (SAB).
In a retrospective study in two Dutch hospitals, we included all patients with SAB between 2013 and 2020 with one or more orthopedic implants in whom [F]FDG-PET/CT was performed. The primary outcome was the percentage of patients who had an orthopedic implant-related infection by S. aureus. We also compared clinical parameters in patients with clinically suspected and unsuspected implants.
Fifty-five of 191 (29%) orthopedic implants in 118 SAB patients included had clinical signs of infection. Of all 136 unsuspected implants, 5 (3%, all arthroplasties), showed increased [F]FDG uptake around the prosthesis on [F]FDG-PET/CT. The clinical course of these patients without clinically overt infection or relapse of bacteremia during follow-up of a median of 48 months (range 0-48), however, argued against prosthetic joint infection.
Although orthopedic implants are evidently a risk factor for metastatic infection during SAB, the absence of clinical symptoms obviate the need of additional investigations or prolonged antibiotic treatment.
评估金黄色葡萄球菌菌血症 (SAB) 患者中临床隐匿性骨科植入物发生隐匿性感染的可能性。
在荷兰的两家医院进行的回顾性研究中，我们纳入了 2013 年至 2020 年间所有患有 SAB 且存在一个或多个骨科植入物的患者，这些患者均进行了[F]FDG-PET/CT 检查。主要结局是由金黄色葡萄球菌引起的与骨科植入物相关感染的患者比例。我们还比较了临床疑似和未疑似植入物患者的临床参数。
在 118 例 SAB 患者的 191 个骨科植入物中，有 55 个（29%）有感染的临床体征。在所有 136 个未被怀疑的植入物中，有 5 个（3%，均为关节置换术）在[F]FDG-PET/CT 上显示假体周围[F]FDG 摄取增加。这些患者在中位随访 48 个月（范围 0-48）期间无临床显性感染或菌血症复发，因此，临床病程不支持假体关节感染。
尽管骨科植入物显然是 SAB 期间转移性感染的危险因素，但缺乏临床症状可以排除进一步检查或延长抗生素治疗的需要。
