title: Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on diagnosis and antimicrobial utilization in patients with high-risk febrile neutropenia.
abstract: Early and targeted antimicrobial therapy improves outcomes in patients with febrile neutropenia (FN). We evaluated the impact of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) on antimicrobial utilization in the management of FN. A cohort of patients with FN and hematological malignancy was identified. Cases (in whom FDG-PET was performed, n = 37) were compared with controls (in whom conventional investigations excluding FDG-PET were performed, n = 76). An underlying cause for FN was determined in 94.6% of cases, compared to 69.7% of controls. FDG-PET had a significant impact on antimicrobial utilization compared to conventional imaging (35.1% vs. 11.8%; p = 0.003), and was associated with shorter duration of liposomal amphotericin-B therapy for systemic fungal infection (median 4.0 days cases vs. 10.0 days controls; p = 0.001). Cases had a longer length of hospitalization (p = 0.016). In the management of patients with high-risk FN, FDG-PET improves diagnostic yield and allows rationalization of antifungal therapy. The impact upon healthcare costs associated with antimicrobial therapy for FN requires further evaluation.
authors.affiliation: Department of Internal Medicine, International Medical University, Seremban, Negeri Sembilan, Malaysia. kweechoy_koh@imu.edu.my
authors.forename: Kwee Choy
authors.initials: KC
authors.lastname: Koh
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.forename: Karin A
authors.initials: KA
authors.lastname: Thursky
authors.forename: Eddie
authors.initials: E
authors.lastname: Lau
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Drummond
authors.forename: Peng Shyan
authors.initials: PS
authors.lastname: Wong
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D005260:Female; D005334:Fever / Q000209:etiology; D019788:Fluorodeoxyglucose F18; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D009503:Neutropenia / Q000175:diagnosis* / Q000209:etiology; D049268:Positron-Emission Tomography; D012306:Risk; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D019788:Fluorodeoxyglucose F18