Impact of 18F-FDG-PET/CT on the management of Staphylococcus aureus bacteraemia: A retrospective observational study / Impacto de la 18F-FDG-PET/TC en el manejo de la bacteriemia por Staphylococcus aureus: resultados de un estudio retrospectivo observacional

Objectives: To assess the impact of 18F-FDG-PET/CT on the diagnosis and management of patients with Staphylococcus aureus bacteraemia (SAB). Methods: Post hoc analysis of a prospective cohort of consecutive adult patients diagnosed with SAB (January 2013–December 2017). Patients who underwent 18F-FDG-PET/CT at the discretion of the attending physician were included. Endpoints were the identification of previously unknown infectious foci and changes in clinical management, defined as changes in the duration or class of antibiotic therapy, a surgical procedure on the source of infection or a change in the decision to remove or retain an implantable device. Results: We included 39 patients (median age: 69 years, IQR: 60–79). Fifteen (39%) patients did not have an infectious focus identified before 18F-FDG-PET/CT. Thirty new infectious foci were detected in 22/39 (56%) patients. In 11/15 (73%) patients without an identified focus at least one infectious focus was detected by 18F-FDG-PET/CT. In 22/26 (85%) patients with implantable devices, 18F-FDG-PET/CT confirmed or ruled out infection or detected local complications. Out of 13 device infections, 10 were detected by 18F-FDG-PET/CT (7/10 for the first time). In 19/39 (49%) patients 18F-FDG-PET/CT results led to changes in clinical management (15 changes in antibiotic therapy, 2 device removals, 2 surgical procedures, 1 avoidance of a surgical procedure). Conclusions: 18F-FDG-PET/CT may be a useful asset in the management of selected SAB cases, allowing the identification of previously undetected infectious foci and optimization of therapy, particularly in patients with endovascular devices. Indication should be made on a case-by-case basis.(AU)

Objetivos: Evaluar el impacto de la 18F-FDG-PET/TC en el diagnóstico y manejo de los pacientes con bacteriemia por Staphylococcus aureus (BSA). Métodos: Análisis post hoc de una cohorte prospectiva de pacientes adultos consecutivos con BSA (enero 2013-diciembre 2017). Se incluyeron aquellos pacientes en los que se realizó una 18F-FDG-PET/TC a criterio del médico tratante. Los criterios de valoración fueron la identificación de nuevos focos infecciosos y los cambios en el manejo clínico (definidos como modificaciones en la duración o clase del tratamiento antibiótico, intervención quirúrgica sobre el foco infeccioso o cambios en la decisión de retirar o mantener un dispositivo implantable). Resultados: Se incluyeron 39 pacientes (edad media: 69 años; RIC: 60-79). En 15 (39%) pacientes no se había identificado un foco infeccioso antes de la 18F-FDG-PET/TC. Se identificaron 30 nuevos focos infecciosos en 22/39 (56%) pacientes. En 11/15 (73%) pacientes sin un foco infeccioso identificado la 18F-FDG-PET/TC detectó al menos un foco infeccioso. En 22/26 (85%) pacientes con dispositivos implantables la 18F-FDG-PET/TC permitió confirmar/descartar infección del dispositivo o detectar complicaciones locales. Diez de 13 infecciones de dispositivos fueron detectadas por 18F-FDG-PET/TC (7/10 desconocidas previamente). En 19/39 (49%) pacientes los hallazgos en la 18F-FDG-PET/TC conllevaron cambios en el manejo clínico (15 modificaciones de tratamiento antibiótico, 2 retiradas de dispositivo, 2 intervenciones quirúrgicas, un procedimiento quirúrgico evitado). Conclusiones: La 18F-FDG-PET/TC puede ser de utilidad en la BSA, ya que permite identificar nuevos focos infecciosos y modificar el manejo clínico, sobre todo en pacientes con dispositivos endovasculares. La indicación ha de individualizarse en cada paciente.(AU)

Impact of 18F-FDG-PET/CT on the management of Staphylococcus aureus bacteraemia: a retrospective observational study.

OBJECTIVES: To assess the impact of 18F-FDG-PET/CT on the diagnosis and management of patients with Staphylococcus aureus bacteraemia (SAB). METHODS: Post hoc analysis of a prospective cohort of consecutive adult patients diagnosed with SAB (January 2013-December 2017). Patients who underwent 18F-FDG-PET/CT at the discretion of the attending physician were included. Endpoints were the identification of previously unknown infectious foci and changes in clinical management, defined as changes in the duration or class of antibiotic therapy, a surgical procedure on the source of infection or a change in the decision to remove or retain an implantable device. RESULTS: We included 39 patients (median age: 69 years, IQR:60-79). Fifteen (39%) patients did not have an infectious focus identified before 18F-FDG-PET/CT). Thirty new infectious foci were detected in 22/39 (56%) patients. In 11/15 (73%) patients without an identified focus at least one infectious focus was detected by 18F-FDG-PET/CT. In 22/26 (85%) patients with implantable devices, 18F-FDG-PET/CT confirmed or ruled out infection or detected local complications. Out of 13 device infections, 10 were detected by 18F-FDG-PET/CT (7/10 for the first time). In 19/39 (49%) patients 18F-FDG-PET/CT results led to changes in clinical management (15 changes in antibiotic therapy, 2 device removals, 2 surgical procedures, 1 avoidance of a surgical procedure). CONCLUSIONS: 18F-FDG-PET/CT may be a useful asset in the management of selected SAB cases, allowing the identification of previously undetected infectious foci and optimization of therapy, particularly in patients with endovascular devices. Indication should be made on a case-by-case basis.

Usefulness of the FDG PET/CT in the management of cystic echinococcosis: A pilot study.

OBJECTIVES: Cystic echinococcosis is a zoonotic disease caused by the cestode Echinococcus granulosus. The activity of the cysts is assessed through the WHO-IWGE standardized classification based on ultrasound features. However, viability of the cysts is not always concordant with the activity assessed by ultrasound. The aim of the present study is to describe the metabolic activity of cysts in patients with cystic echinococcosis through FDG-PET. METHODS: Prospective observational study where adult patients diagnosed of cystic echinococcosis were offered to undergo FDG PET/CT before treatment onset. Demographic, clinical, radiological, and histopathological information was collected from all patients. RESULTS: Sixteen patients were included, 50% were male, and age ranged from 18 to 85 years. Most of the patients had liver involvement, and all patients had CE3, CE4 or CE5 stage of the WHO-IWGE classification. Only one patient (CE5) had an increased 18F-FDG uptake of the cyst in the FDG PET/CT. From the 5 patients who underwent surgical treatment, only one showed signs of viability of the cyst: a patient with CE5 with no increased 18F-FDG uptake of the cyst. CONCLUSION: In our pilot study, we did not find the correlation between the FDG PET/CT imaging and the cystic echinococcosis cyst bioactivity.

Usefulness of FDG PET/CT in the management of tuberculosis.

BACKGROUND: The aim of our study is to describe the FDG-PET/CT findings in patients with tuberculosis and to correlate them with the patient's prognosis. METHODS: We retrospectively collected data from patients with tuberculosis, who had an FDG-PET/CT performed prior to treatment initiation from 2010 to 2015. RESULTS: Forty-seven out of 504 patients with active tuberculosis diagnosis (9.33%) underwent an FDG-PET/CT. The reasons for performing the FDG-PET/CT were: characterization of a pulmonary nodule (24; 51.1%), study of fever of unknown origin (12; 25.5%), study of lymph node enlargement (5; 10.6%) and others (6; 12.8%). Median age was 64 (IQR 50-74) years and 31 (66%) patients were male. Twenty-six (55.3%) patients had an immunosuppressant condition. According to the FDG-PET/CT, 48.6% of the patients had more than 1 organ affected and 46.8% had lymph node involvement. Median SUVmax of the main lesion was 5 (IQR 0.28-11.85). We found an association between the FDG accumulation and the size of the main lesion with a correlation coefficient of 0.54 (p<0.002). Patients with an unsuccessful outcome had a higher ratio SUVmax main lesion / SUVmean liver (1.92 vs 7.67, p<0.02). CONCLUSIONS: In our cohort, almost half of the patients had more than 1 organ affected and 46.8% of them had lymph node involvement. FDG uptake was associated with the size of the main lesion and seems to be related to the treatment outcome. The extent of its potential to be used as an early predictor of treatment success still needs to be defined.

Síndrome del mentón entumecido. A propósito de un caso / Numb chin syndrome. A case report

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