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FDG-PET/CT for Detecting an Infection Focus in Patients With Bloodstream Infection: Factors Affecting Diagnostic Yield

Pijl, J. P., Glaudemans, A. W. J. M., Slart, R. H. J. A., Yakar, D., Wouthuyzen-Bakker, M. & Kwee, T. C., Feb-2019, In : Clinical Nuclear Medicine. 44, 2, p. 99-106 8 p.

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  • FDG-PET/CT for Detecting an Infection Focus in Patients With Bloodstream Infection

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PURPOSE: To investigate the diagnostic performance of F-fluoro-2-deoxy-D-glucose (FDG) PET/ CT for the detection of an infection focus in patients with a bloodstream infection (BSI) and to identify factors influencing the diagnostic yield of FDG-PET/CT.

METHODS: This retrospective single-center study included 185 consecutive patients with a BSI who underwent an FDG-PET/CT scan for the detection of an infection focus between 2010 and 2017. The final diagnosis at hospital discharge was used as reference standard. Diagnostic performance of FDG-PET/CT for the detection of an infection focus was assessed, and logistic regression analyses were performed to identify factors associated with FDG-PET/CT yield.

RESULTS: An infection focus was identified on FDG-PET/CT in 120 (64.8%) of 185 patients. FDG-PET/CT achieved a sensitivity of 80.2%, specificity of 79.6%, positive predictive value of 90.8%, and a negative predictive value of 61.4% for detecting an infection focus in patients with a BSI. Blood cultures positive for enterococci (odds ratio, 0.14; P = 0.019) and days of antibiotic treatment before FDG-PET/CT (odds ratio, 0.94 per day increase; P = 0.014) were statistically significant independent predictors of a lower odds of detecting an infection focus on FDG-PET/CT. In patients who received antibiotics for less than 7 days before FDG-PET/CT, an infection focus was found in 71% (56/79). In patients who received antibiotics for 8 to 14 days before FDG-PET/CT, an infection focus was found in 52% (22/42). After 15 to 21 days of antibiotic treatment, an infection focus was found in 61% (8/13), and for 22 days or more, this declined to 38% (5/13).

CONCLUSIONS: FDG-PET/CT is a useful method for detecting an infection focus in patients with BSI. However, longer duration of antibiotic treatment before FDG-PET/CT and bacteremia with enterococci reduce the diagnostic yield of FDG-PET/CT. These factors should be taken into account when considering an FDG-PET/CT scan for this indication.

Original languageEnglish
Pages (from-to)99-106
Number of pages8
JournalClinical Nuclear Medicine
Volume44
Issue number2
Publication statusPublished - Feb-2019

    Keywords

  • FDG-PET/CT, infection, focus, bacteremia, sepsis, F-18-FDG PET/CT, COST-EFFECTIVENESS, 30-DAY MORTALITY, BACTEREMIA, INFLAMMATION, RESISTANCE, PITFALLS

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