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Predictors of infectious foci on FDG PET/CT in Staphylococcus aureus bacteremia
Nesrin Ghanem-Zoubi1,2, Jawad Abu-Elhija3, Olga Kagna4,5
1Infectious Diseases Institute, Rambam Health Care Campus, Ha-Aliya 8 St, 3109601, Haifa, Israel. n_ghanem@rambam.health.gov.il.
Abstract:
We looked for predicting factors for the detection of infectious foci on 18F-fluorodeoxyglucose-positron emission tomography in combination with computed tomography (FDG PET/CT) among patients with Staphylococcus aureus bacteremia (SAB) who participated in an interventional study that was conducted at Rambam Health Care Campus, between July 1, 2015 and February 1, 2019. The primary outcome was an infectious focus detected by FDG PET/CT. Independent predictors for detection of focal infection were identified using univariate followed by a logistic regression multivariate analysis. We included 149 patients with 151 separate episodes of SAB who underwent FDG-PET/CT. Focal infections were detected in 107 patients (70.8%). Independent predictors for focal infection detection were community acquisition of bacteremia with odds ratio (OR) 3.03 [95% confidence interval (CI) 1.04-8.77], p-0.042 and C reactive protein (CRP) with OR 1.09 [95% CI 1.04-1.14], p < 0.001. Primary bacteremia was inversely associated with focal infection detection with OR 0.27 [0.10-0.69], p = 0.007, as were the pre-scan blood glucose levels OR 0.9 [0.98-0.99], p-0.004. The latter stayed significant in the subgroup of patients with diabetes mellitus. To conclude, patients with community-acquired bacteremia or high CRP levels should be carefully investigated for focal infection. Patients who present with primary bacteremia seem to be at low risk for focal infection.
Insights
Community-acquired Staphylococcus aureus bacteremia (SAB) and high C-reactive protein (CRP) levels predict infectious foci detection on FDG PET/CT scans. Primary bacteremia and lower blood glucose levels indicate a lower risk of focal infection.
Area of Science:
- Nuclear medicine
- Infectious diseases
- Radiology
Background:
- Staphylococcus aureus bacteremia (SAB) poses a significant risk for developing infectious foci.
- Early detection of infectious foci is crucial for effective SAB management.
- 18F-fluorodeoxyglucose-positron emission tomography in combination with computed tomography (FDG PET/CT) is a valuable imaging modality for identifying infection sites.
Purpose of the Study:
- To identify predicting factors for the detection of infectious foci using FDG PET/CT in patients with SAB.
- To determine independent predictors associated with focal infection detection in SAB patients.
Main Methods:
- Retrospective analysis of 149 patients with 151 SAB episodes undergoing FDG PET/CT.
- Univariate and logistic regression multivariate analyses were employed to identify independent predictors.
- Primary outcome was the detection of an infectious focus by FDG PET/CT.
Main Results:
- Focal infections were detected in 70.8% of SAB patients.
- Community acquisition of bacteremia (OR 3.03) and elevated C-reactive protein (CRP) levels (OR 1.09) were independent predictors for focal infection detection.
- Primary bacteremia (OR 0.27) and lower pre-scan blood glucose levels (OR 0.9) were inversely associated with focal infection detection, with glucose levels remaining significant in diabetic patients.
Conclusions:
- Patients with community-acquired SAB or high CRP levels require thorough investigation for focal infections using FDG PET/CT.
- FDG PET/CT aids in identifying infectious foci in SAB, guiding treatment strategies.
- Primary bacteremia and controlled blood glucose levels may indicate a lower likelihood of disseminated infection in SAB patients.
