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Clinical value of FDG-PET/CT in bacteremia of unknown origin with catalase-negative gram-positive cocci or Staphylococcus aureus

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Introduction

Bacteremia is associated with high mortality, especially when the site of infection is unknown. While conventional imaging usually focus on specific body parts, FDG-PET/CT visualizes hypermetabolic foci throughout the body.

Purpose

To investigate the ability of FDG/PET-CT to detect the site of infection and its clinical impact in bacteremia of unknown origin with catalase-negative Gram-positive cocci (excluding pneumococci and enterococci) or Staphylococcus aureus (BUOCSA).

Methods

We retrospectively identified 157 patients with 165 episodes of BUOCSA, who subsequently underwent FDG-PET/CT. Data were collected from medical records. Decision regarding important sites of infection in patients with bacteremia was based on the entire patient course and served as reference diagnosis for comparison with FDG-PET/CT findings. FDG-PET/CT was considered to have high clinical impact if it correctly revealed site(s) of infection in areas not assessed by other imaging modalities or if other imaging modalities were negative/equivocal in these areas, or if it established a new clinically relevant diagnosis, and/or led to change in antimicrobial treatment.

Results

FDG-PET/CT detected sites of infection in 56.4% of cases and had high clinical impact in 47.3%. It was the first imaging modality to identify sites of infection in 41.1% bacteremia cases, led to change of antimicrobial therapy in 14.7%, and established a new diagnosis unrelated to bacteremia in 9.8%. Detection rate and clinical impact were not significantly influenced by duration of antimicrobial treatment preceding FDG-PET/CT, days from suspicion of bacteremia to FDG-PET/CT-scan, type of bacteremia, or cancer.

Conclusion

FDG-PET/CT appears clinically useful in BUOCSA. Prospective studies are warranted for confirmation.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Indgang 44, 46, 5000, Odense C, Denmark

    Mette Bordinggaard Brøndserud, Poul F. Høilund-Carlsen & Søren Hess

  2. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark

    Mette Bordinggaard Brøndserud, Court Pedersen & Poul F. Høilund-Carlsen

  3. Department of Rheumatology, Odense University Hospital, Kløvervænget 5, Indgang 132 1, 5000, Odense C, Denmark

    Mette Bordinggaard Brøndserud

  4. Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, 5000, Odense C, Denmark

    Court Pedersen

  5. Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 2, 5000, Odense C, Denmark

    Flemming S. Rosenvinge

  6. Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark

    Søren Hess

  7. Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 23, 3, 5000, Odense C, Denmark

    Søren Hess

Authors
  1. Mette Bordinggaard Brøndserud
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  2. Court Pedersen
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  3. Flemming S. Rosenvinge
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Corresponding author

Correspondence to Mette Bordinggaard Brøndserud.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

The study was approved by the Danish Data Protection Agency (no. 14/28781, 2008-58-003) and The Danish Health Authority (no. 3-3013-675/1/). For this type of study, formal consent is not required.

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Brøndserud, M.B., Pedersen, C., Rosenvinge, F.S. et al. Clinical value of FDG-PET/CT in bacteremia of unknown origin with catalase-negative gram-positive cocci or Staphylococcus aureus. Eur J Nucl Med Mol Imaging 46, 1351–1358 (2019). https://doi.org/10.1007/s00259-019-04289-5

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  • DOI: https://doi.org/10.1007/s00259-019-04289-5

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