18F-FDG PET/CT Optimizes Treatment inStaphylococcus AureusBacteremia and Is Associated with Reduced Mortality.
Metastatic infection is an important complication ofStaphylococcus aureusbacteremia (SAB). Early diagnosis of metastatic infection is crucial, because specific treatment is required. However, metastatic infection can be asymptomatic and difficult to detect. In this study, we investigated the role of18F-FDG PET/CT in patients with SAB for detection of metastatic infection and its consequences for treatment and outcome.Methods:All patients with SAB at Radboud University Medical Center were included between January 2013 and April 2016. Clinical data and results of18F-FDG PET/CT and other imaging techniques, including echocardiography, were collected. Primary outcomes were newly diagnosed metastatic infection by18F-FDG PET/CT, subsequent treatment modifications, and patient outcome.Results:A total of 184 patients were included, and18F-FDG PET/CT was performed in 105 patients, of whom 99 had a high-risk bacteremia.18F-FDG PET/CT detected metastatic infectious foci in 73.7% of these high-risk patients. In 71.2% of patients with metastatic infection, no signs and symptoms suggesting metastatic complications were present before18F-FDG PET/CT was performed.18F-FDG PET/CT led to a total of 104 treatment modifications in 74 patients. Three-month mortality was higher in high-risk bacteremia patients without18F-FDG PET/CT performed than in those in whom18F-FDG PET/CT was performed (32.7% vs. 12.4%,P= 0.003). In multivariate analysis,18F-FDG PET/CT was the only factor independently associated with reduced mortality (P= 0.005; odds ratio, 0.204; 95% confidence interval, 0.066-0.624). A higher comorbidity score was independently associated with increased mortality (P= 0.003; odds ratio, 1.254; 95% confidence interval, 1.078-1.457).Conclusion:18F-FDG PET/CT is a valuable technique for early detection of metastatic infectious foci, often leading to treatment modification. Performing18F-FDG PET/CT is associated with significantly reduced 3-mo mortality.
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands Marvin.Berrevoets@radboudumc.nl.
Marvin A H
MAH
Berrevoets
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Ilse J E
IJE
Kouijzer
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Erik H J G
EHJG
Aarntzen
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Marcel J R
MJR
Janssen
Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.|MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
Lioe-Fee
LF
De Geus-Oei
Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands; and.
Heiman F L
HFL
Wertheim
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Bart-Jan
BJ
Kullberg
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Jaap Ten
JT
Oever
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.|Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom.
Wim J G
WJG
Oyen
Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Chantal P
CP
Bleeker-Rovers
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
D019788:Fluorodeoxyglucose F18
18F-FDG PET/CT; Staphylococcus aureus; metastatic infection