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The role of [18F]FDG-PET/CT in gram-positive and gram-negative bacteraemia: A systematic review
Alice Packham1, Niamh Spence1, Tanveer Bawa1
1Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Objectives:
Bacteraemia is associated with significant morbidity and mortality. [18F]FDG-PET/CT is increasingly used to detect infectious metastatic foci, however there remains international variation in its use. We performed a systematic review assessing the impact of [18F]FDG-PET/CT in adult inpatients with gram-positive and Gram-negative bacteraemia.
Design:
The systematic review was performed according to PRISMA guidelines. Studies published between 2009 and December 2021 were searched in MEDLINE, EMBASE and Cochrane clinical trials database. Data extraction and quality assessment was performed using ROBINS-I and GRADE.
Setting:
Eligible study designs included randomised-controlled trials, clinically-controlled trials, prospective trials, retrospective trials, case-control studies, and non-controlled studies.
Participants:
Studies solely assessing adult inpatients with blood-culture confirmed bacteraemia with one cohort of patients receiving [18F]FDG-PET/CT were included.
Main Outcome Measures:
primary outcomes were mortality, identification of metastatic foci and relapse rate. Studies not examining any of the pre-specified outcomes were excluded.
Results:
Ten studies were included, of which five had a non-PET/CT control arm. Overall, there was low quality of evidence that [18F]FDG-PET/CT is associated with reduced mortality, improved identification of metastatic foci and reduced relapse rate. Six studies assessed Staphylococcus aureus bacteraemia (SAB) only; nine studies included Gram-positive bacteraemia only, and one study included data from Gram-negative bacteraemia. Two studies compared outcomes between patients with different types of bacteraemia. Four studies identified a statistically significant difference in mortality in [18F]FDG-PET/CT recipients and controls. Relapse rate was significantly reduced in patients with SAB who received [18F]FDG-PET/CT. Studies identified significantly higher detection of metastatic foci in [18F]FDG-PET/CT recipients compared to controls. [18F]FDG-PET/CT was the first to identify an infectious site in 35.5% to 67.2% of overall foci identified.
Conclusions:
Further research is required to establish the role of [18F]FDG-PET/CT in bacteraemia, and its impact on management and mortality.
Insights
This systematic review found low-quality evidence that [18F]FDG-PET/CT may help detect metastatic foci and reduce relapse rates in patients with bacteraemia. Further research is needed to confirm its impact on mortality and management.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Nuclear Medicine
Background:
- Bacteraemia poses significant risks, increasing morbidity and mortality.
- [18F]FDG-PET/CT is increasingly utilized for detecting infectious metastatic foci.
- International variations exist in the application of [18F]FDG-PET/CT for bacteraemia.
Purpose of the Study:
- To systematically review the impact of [18F]FDG-PET/CT on adult inpatients diagnosed with Gram-positive and Gram-negative bacteraemia.
- To assess the effectiveness of [18F]FDG-PET/CT in identifying metastatic foci, reducing mortality, and lowering relapse rates.
- To evaluate the quality of evidence supporting the use of [18F]FDG-PET/CT in bacteraemia management.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Studies published between 2009 and December 2021 were searched across MEDLINE, EMBASE, and Cochrane clinical trials databases.
- Data extraction and quality assessment utilized ROBINS-I and GRADE criteria, including RCTs, prospective, retrospective, and case-control studies.
Main Results:
- Ten studies were included, with five featuring a non-PET/CT control group.
- Low-quality evidence suggests [18F]FDG-PET/CT may reduce mortality, improve metastatic foci identification, and lower relapse rates.
- Studies showed significantly higher detection of metastatic foci and reduced relapse rates in *Staphylococcus aureus* bacteraemia patients receiving [18F]FDG-PET/CT.
Conclusions:
- The current evidence quality regarding [18F]FDG-PET/CT's impact on mortality and relapse rates in bacteraemia is low.
- [18F]FDG-PET/CT demonstrated a higher detection rate for infectious metastatic foci compared to controls.
- Further research is essential to establish the definitive role of [18F]FDG-PET/CT in bacteraemia management and its effect on patient outcomes.
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