Abstract Background Staphylococcus aureus bacteremia (SAB) is uniquely characterized by focal pyogenic complications that might not be apparent clinically. We investigated the benefit of adding FDG-PET/CT in the workup of patients with SAB. Methods Matched-cohort study. Patients with SAB (intervention group) were prospectively recruited to undergo FDG-PET/CT 7-14 days after diagnosis. Treatment was directed by FDG-PET/CT findings. Clinical outcomes were compared to a control group of patients with SAB who had not undergone FDG-PET/CT, matched by age, Charlson score, methicillin susceptibility and survival duration to FDG-PET/CT. The primary outcome was 90-day mortality. Residual confounding was controlled through regression analyses. Results During the study period 149 patients with 151 separate episodes of SAB underwent FDG-PET/CT and were compared to 150 matched patients with 151 SAB episodes. Patients in the intervention group acquired infections more frequently in the community, had less frequently solid malignancies and more frequently high-risk SAB. Ninety-day mortality in the intervention group was significantly lower than in the control group [21/151 (13.9%) vs. 43/151 (28.5%), p=0.002]. The difference remained significant in a subgroup analysis of patients with community-onset infections without malignancy and among patients with low-risk SAB. Controlling for other risk factors for mortality, FDG-PET/CT performance among all patients was independently associated with lower mortality, odds ratio 0.39, 95% confidence interval 0.18-0.84. Patients in the intervention group had longer duration of treatment and more focus control procedures performed compared to the control group. Conclusion FDG-PET/CT in patients with SAB seems to improve survival through guidance of treatment duration and co-interventions.

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Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.

Purpose: To identify risk factors for 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). Methods: Cohort study of patients with SAB who underwent FDG PET/CT as part of an interventional study that was conducted at Rambam Health Care Campus, between July 1, 2015 to February 1, 2019. The primary outcome was an infectious focus detected by FDG PET/CT. Independent risk factors for detection of focal infection were identified using univariate followed by a logistic regression multivariate analysis. Results: 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 risk factors 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. Conclusion: Patients with community-acquired bacteremia or high CRP levels should be carefully investigated for focal infection. Patients who present with primary bacteremia seems to be at low risk for focal infection. Further studies should evaluate whether high glucose levels may result in false-negative infectious findings on FDG PET/CT.