Abstract
Background2-Deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is an advanced imaging technique that can be used to examine the whole body for an infection focus in a single examination in patients with bloodstream infection (BSI) of unknown origin. However, literature on the use of this technique in intensive care patients is scarce. The purpose of this study was to evaluate the diagnostic yield of FDG-PET/CT in intensive care patients with BSI.MethodsIn this retrospective cohort study, all intensive care patients from our Dutch university medical center who had culture-proven BSI between 2010 and 2020 and underwent FDG-PET/CT to find the focus of infection were included. Diagnostic performance was calculated and logistic regression analysis was performed to evaluate the association between FDG-PET/CT outcome and C-reactive protein level (CRP), leukocyte count, duration of antibiotic treatment, duration of ICU stay, quality of FDG-PET/CT, and dependency on mechanical ventilation. In addition, the impact of FDG-PET/CT on clinical treatment was evaluated.Results30 intensive care patients with BSI were included. In 21 patients, an infection focus was found on FDG-PET/CT which led to changes in clinical management in 14 patients. FDG-PET/CT achieved a sensitivity of 90.9% and specificity of 87.5% for identifying the focus of infection. Poor quality of the FDG-PET images significantly decreased the likelihood of finding an infection focus as compared to reasonable or good image quality (OR 0.16, P = 0.034). No other variables were significantly associated with FDG-PET/CT outcome. No adverse events during the FDG-PET/CT procedure were reported.ConclusionFDG-PET/CT has a high diagnostic yield for detecting the infection focus in patients with BSI admitted to intensive care. Poor PET image quality was significantly associated with a decreased likelihood of finding the infection focus in patients with BSI. This could be improved by adequate dietary preparation and cessation of intravenous glucose and glucose-regulating drugs. Recent advances in PET/CT technology enable higher image quality with shorter imaging time and may contribute to routinely performing FDG-PET/CT in intensive care patients with BSI of unknown origin.
Highlights
Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the bloodstream [1]
BSI was most commonly caused by Staphylococcus aureus (37%) and Enterococcus faecium (13%)
The results of this study show that FDG-positron emission tomography (PET)/CT can be a valuable tool in detecting the infection focus in patients with BSI admitted to intensive care units without a clear focus of infection despite conventional diagnostic workup
Summary
Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the bloodstream [1]. BSI may lead to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [2]. Pijl et al Crit Care (2021) 25:133 approximately 6% in all hospitalized patients and a mortality rate of approximately 15%, BSI is one of the most common causes of hospitalization and mortality in Western countries [4, 5]. BSI affects 10–20% of all patients admitted to intensive care and causes a threefold increase in mortality in this population [4,5,6]. An uncontrolled source of infection is independently associated with mortality in BSI. Source localization in BSI is of vital importance [6]. The source of BSI can often be diagnosed with conventional diagnostics such as ultrasonography, plain X-ray, computed tomography or microbiologic cultures, the source may remain unknown in some patients even after extensive diagnostic workup, potentially delaying adequate treatment
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