1994. The use of whole body PET scans in management of infective endocarditis

Abstract

Abstract Background Whole-body 18F-FDG PET/CT (WBP) can have diagnostic utility in evaluating extracardiac sites of metastatic infection in patients with infective endocarditis (IE). However, the IE patient population that most benefits from this test is not certain. The purpose of this study is to investigate the clinical characteristics of patients with IE who had WBP performed and to evaluate how WBP results impacted management. Methods We performed a retrospective cohort study at a tertiary care center evaluating patients with suspected IE who were discussed at an internal multidisciplinary endocarditis conference between June 2018 and January 2022. Adult patients with suspected IE who also had a WBP during their inpatient stay were included. Patient demographics, IE risk factors, and WBP details were collected. Results 114 patients with suspected IE had a WBP out of 431 (26.5%). The majority (n=107, 93.9%) had definite or possible IE by mDuke criteria. Prosthetic valves and endocardial devices were present in 83 (72.8%) and 34 (29.8%) patients respectively. There were 67 (60.5%) patients with 2 or more days of bacteremia and 21 (22.1%) patients with over 7 days of bacteremia. Causative pathogens included S. aureus (n=26, 24.2%), Enterococcus (n=26, 24.2%), and Streptococcus species (n=24, 22.4%). Among the 70 (61.4%) patients with indications for cardiac surgery, 38 (54%) had cardiac surgery performed. Common WBP findings were bone/joint infections (n=18, 15.8%), pulmonary infection (n=32, 28.1%), and skin/soft tissue infection (n=15, 13.2%). WBP changed the management in 44.7% (n=51) of patients, including antibiotic change (n=11, 9.7%), source control procedure (n=12, 10.5%), and further workup of infectious or non-infectious findings (n=33, 29.0%). Six-month all-cause mortality was 25% and hospital readmission was 48.1%. Conclusion Many patients who underwent WBP had prolonged bacteremia, a history of cardiac prostheses, and had complicated IE with indications for cardiac surgery. WBP results changed treatment in some cases, but true clinical impact on morbidity and mortality is uncertain. We plan to do further research to compare outcomes between patients who get WBP and those who do not and to determine which patients may most benefit from this test. Disclosures All Authors: No reported disclosures.