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Echocardiography and FDG-PET/CT scan in Gram-negative bacteremia and cardiovascular infections
Anders Dahl1,2, M Hernandez-Meneses1, A Perissinotti3
1Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
Insights
Diagnosing cardiovascular infections in Gram-negative bloodstream infections (GNBSI) requires targeted imaging. Transesophageal echocardiography (TEE) and FDG-PET/CT are crucial for specific patient groups, especially those with vascular grafts or device infections.
Area of Science:
- Infectious Diseases
- Cardiology
- Radiology
Background:
- Gram-negative bloodstream infections (GNBSI) can lead to cardiovascular complications.
- Cardiovascular infections are relatively uncommon in GNBSI, ranging from 1-5% for endocarditis and cardiac implantable electronic device (CIED) infections.
- Vascular graft infections caused by GNBSI are more prevalent, estimated at 30-40%.
Purpose of the Study:
- To review current evidence on diagnosing cardiovascular infections in patients with GNBSI.
- To evaluate the utility of transesophageal echocardiography (TEE) and 18F-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic workup of GNBSI-related cardiovascular infections.
Main Methods:
- Literature review of current evidence on cardiovascular infections in GNBSI.
- Focus on the application of TEE and FDG-PET/CT in diagnostic strategies.
- Analysis of infection proportions and prevalence in different cardiovascular sites.
Main Results:
- Endocarditis workup (TEE and FDG-PET/CT) is recommended for GNBSI patients with native/prosthetic valves only if relapse or suggestive signs are present.
- Patients with GNBSI and CIED infections, particularly with Pseudomonas or Serratia spp., benefit from TEE and FDG-PET/CT due to high infection prevalence.
- GNBSI in patients with vascular grafts warrants consideration of FDG-PET/CT.
Conclusions:
- Diagnostic imaging like TEE and FDG-PET/CT should be selectively applied in GNBSI patients based on specific risk factors and clinical presentation.
- Early and accurate diagnosis of cardiovascular involvement in GNBSI can guide appropriate treatment and improve patient outcomes.
- Further research may clarify optimal diagnostic pathways for various GNBSI-related cardiovascular infections.
Purpose Of Review:
Current evidence on cardiovascular infections in Gram-negative blood stream infections (GNBSI) with focus on the use of transesophageal echocardiography (TEE) and 18F-Fluorodeoxyglucose - positron emission tomography/Computed tomography (FDG-PET/CT) in the diagnostic workup.
Recent Findings:
Most evidence focuses on characteristics of diagnosed cardiovascular infections and the proportion caused by GNBSI. These proportions are low (1-5%) when it comes to native and prosthetic valve endocarditis as well as cardiac implantable electronic device (CIED) infections whereas the proportion of vascular graft infections caused by GNBSI seems substantially higher (30-40%). Information on the prevalence of cardiovascular infection in patients with GNBSI is limited to a few studies finding around 3% endocarditis in patients with GNBSI and a prosthetic heart valve and 4-16% device-related infection in patients with CIED and GNBSI.
Summary:
Patients with GNBSI and native or prosthetic valves should only undergo work-up for endocarditis (TEE and FDG-PET/CT) if they present GNBSI relapse or signs suggestive of endocarditis. CIED patients with GNBSI with Pseudomonas or Serratia spp. should undergo TEE and PET/CT because of the high prevalence of device-related infection. In other GNBs without IE suggestive signs, normal BSI treatment is reasonable and only cases with relapse need work-up. GNBSI in patients with vascular grafts should lead to consideration of PET/CT.
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