(18)F-FDG PET/CT-Guided Treatment Duration in Patients with High-Risk Staphylococcus Aureus Bacteremia: A Proof of Principle
until further notice
SourceThe Journal of Nuclear Medicine (1978), 60, 7, (2019), pp. 998-1002
Article / Letter to editor
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The Journal of Nuclear Medicine (1978)
SubjectRadboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences; Radboudumc 4: lnfectious Diseases and Global Health RIMLS: Radboud Institute for Molecular Life Sciences
Current guidelines recommend intravenous antibiotic therapy for at least 4 wk in patients with high-risk Staphylococcus aureus bacteremia (SAB), because of the risk for metastatic infection. We evaluated the safety of a shorter duration of treatment in patients with high-risk SAB without signs of metastatic infection at presentation, using standard (18)F-FDG PET/CT and echocardiography. Methods: Retrospective analyses were performed of patients with SAB admitted between 2013 and 2017 in 2 medical centers. Patients with risk factors for complicated bacteremia (community acquisition, persistently positive blood cultures, >72 h of fever, or foreign body materials present), a normal echocardiography result, and (18)F-FDG PET/CT without signs of metastatic infection were included (cases) and compared with patients with uncomplicated bacteremia (absence of any of the risk factors and no known metastatic disease, controls). Primary outcomes were 3-mo SAB-specific mortality rate and recurrent infection. The secondary outcome was overall mortality. Results: We included 36 cases and 40 controls. Both groups had a similar treatment duration (15.9 vs. 15.4 d). No deaths occurred as a consequence of SAB in the cases, compared with 1 in the control group. One relapse occurred in the case group and 2 in the control group. Overall mortality did not differ between the groups (19.4% vs. 15.0%, P = 0.64). Conclusion: This study suggests that intravenous treatment for 2 wk in high-risk patients with SAB without endocarditis and absence of metastatic infection on (18)F-FDG PET/CT is safe. A diagnostic-driven approach using (18)F-FDG PET/CT to determine treatment duration in high-risk SAB seems feasible and allows tailoring treatment to individual patients.
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