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18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia
Fidel J Vos1, Chantal P Bleeker-Rovers, Patrick D Sturm
1Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. f.vos@aig.umcn.nl
Unlabelled:
The timely detection of metastatic infectious foci in gram-positive bacteremia is crucial, because these foci often require prolonged antibiotic treatment or drainage. The diagnosis of metastatic infectious foci is difficult because localizing symptoms are often absent. We investigated whether (18)F-FDG PET/CT was able to detect such foci and whether detection influenced clinical outcome.
Methods:
One hundred fifteen nonneutropenic patients with gram-positive bacteremia were prospectively included. Patients with positive blood cultures growing Staphylococcus aureus, Streptococcus species, or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. (18)F-FDG PET/CT was performed within 2 wk after the first positive blood culture. Abnormal (18)F-FDG uptake had to be confirmed by radiologic, microbiologic, or pathologic studies. Results were compared with a matched historical control group of 230 patients in whom no (18)F-FDG PET/CT was performed.
Results:
Significantly more patients were diagnosed with metastatic foci in the study group (67.8% vs. 35.7%). Of the imaging investigations performed, (18)F-FDG PET/CT was the first to delineate infectious foci in 35 patients (30%). In the remaining 70%, either symptoms on physical examination or other imaging techniques first revealed infectious foci. The sensitivity, specificity, negative predictive value, and positive predictive value of (18)F-FDG PET/CT were 100%, 87%, 100%, and 89%, respectively. Relapse rates decreased from 7.4% to 2.6% among study patients (P = 0.09) and from 8.9% to 1.4% in patients with S. aureus (P = 0.04). Overall mortality after 6 mo decreased from 32.2% to 19.1% in the (18)F-FDG PET/CT group (P = 0.014).
Conclusion:
In the diagnostic work-up of high-risk patients with gram-positive bacteremia, (18)F-FDG PET/CT is a valuable technique that results in lower mortality rates. In patients with S. aureus bacteremia, relapse rates decreased significantly after the addition of (18)F-FDG PET/CT.
Insights
Early detection of metastatic foci in gram-positive bacteremia using 18F-FDG PET/CT significantly reduces mortality rates. This imaging technique improves diagnosis and outcomes for high-risk patients, particularly those with Staphylococcus aureus infections.
Area of Science:
- Nuclear Medicine
- Infectious Diseases
- Radiology
Background:
- Metastatic infectious foci in gram-positive bacteremia are challenging to detect due to absent localizing symptoms.
- Timely diagnosis is crucial as these foci often necessitate prolonged treatment or drainage.
Purpose of the Study:
- To investigate the efficacy of 18F-FDG PET/CT in detecting metastatic infectious foci in patients with gram-positive bacteremia.
- To determine if the use of 18F-FDG PET/CT influences clinical outcomes, including mortality and relapse rates.
Main Methods:
- Prospective inclusion of 115 nonneutropenic patients with gram-positive bacteremia (Staphylococcus aureus, Streptococcus, Enterococcus species) and risk factors for metastatic foci.
- 18F-FDG PET/CT performed within 2 weeks of positive blood cultures, with abnormal uptake confirmed by other diagnostic methods.
- Comparison with a historical control group of 230 patients who did not undergo 18F-FDG PET/CT.
Main Results:
- Significantly higher diagnosis rates of metastatic foci in the study group (67.8%) compared to the control group (35.7%).
- 18F-FDG PET/CT was the primary imaging modality for detecting infectious foci in 30% of patients.
- Reduced relapse rates (7.4% to 2.6%) and a significant decrease in overall 6-month mortality (32.2% to 19.1%) in the 18F-FDG PET/CT group.
Conclusions:
- 18F-FDG PET/CT is a valuable diagnostic tool for high-risk patients with gram-positive bacteremia, leading to improved clinical outcomes and reduced mortality.
- The addition of 18F-FDG PET/CT significantly decreased relapse rates in patients with Staphylococcus aureus bacteremia.
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