Integration of FDG-PET/CT in the Diagnostic Workup for Staphylococcus aureus Bacteremia: A Prospective Interventional Matched-cohort Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>FDG-PET/CT in patients with SAB seems to improve survival through guidance of treatment duration and co-interventions.</jats:p> </jats:sec>

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

“…Earlier studies have shown that up to 71% of metastatic foci are clinically silent [8], leading to an underestimation of the bacterial burden in SAB patients. 2-[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography with combined computed tomography ([ 18 F]FDG-PET/CT) has a high sensitivity and specificity for metastatic infectious foci [9,10]. Integration of [ 18 F]FDG-PET/CT into the diagnostic workup of patients with SAB reduces mortality rates [8][9][10].…”

“…2-[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography with combined computed tomography ([ 18 F]FDG-PET/CT) has a high sensitivity and specificity for metastatic infectious foci [9,10]. Integration of [ 18 F]FDG-PET/CT into the diagnostic workup of patients with SAB reduces mortality rates [8][9][10]. Proof of concept studies indicate that [ 18 F]FDG-PET/CT can also be used to select patients who are eligible for iv-oral switch [11] or shortening of antibiotic treatment [12].…”

The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in Management of Nocardiosis: A Retrospective Study and Review of the Literature

“…Although none of the cases reported in the literature used FDG-PET/CT for therapy decision-making, it is possible that if used as an auxiliary follow-up tool it can facilitate decisions on treatment duration [50]. Similarly, FDG-PET/CT conducted shortly after the diagnosis of Staphylococcus aureus bacteremia guided treatment duration and improved survival [3]. Furthermore, FDG-PET/CT facilitated monitoring of the initial response to antibiotic therapy in infectious spondylodiscitis [51] and in predicting relapse of pulmonary tuberculosis when conducted at the time of treatment completion [52].…”

“…Integrated positron emission tomography/computed tomography (PET/CT) with 18-fluorodeoxyglucose (FDG) is a useful modality for managing some infections [1], mostly disseminated infections [2,3]. FDG-PET/ CT can predict extracardiac infective endocarditis (IE) complications [4], and contributes to its treatment approach and decision-making [5,6].…”

Update on Staphylococcus aureus bacteraemia

“…In summary, we present and review contemporary studies of SAB across a range of topics not limited to epidemiology, clinical features, multiple positive blood cultures, antibiotic choice and duration. SAB is complex and there are many important aspects that we were not able to explore further at this time including a study with eosinophilia with daptomycin [40], use of oral stepdown therapy with clindamycin [41], improvement of diagnosis using fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) [42,43], source control such as with removal of cardiac implantable electronic devices associated with decreased mortality [44], the importance of serial negative blood cultures [45 & ], and the significance of Staphylococcus aureus bacteriuria in patients with SAB [46 & ]. In addition, optimized use of clinical scoring systems to stratify patients for therapy or best utilize echocardiography resources is a major area of investigation that could merit its own review [47][48][49][50][51][52][53][54].…”