Integration of FDG-PET/CT in the Diagnostic Workup for Staphylococcus aureus Bacteremia: A Prospective Interventional Matched-cohort Study.

Autor:	Ghanem-Zoubi N; Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel., Kagna O; Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel., Abu-Elhija J; Internal Medicine Department E, Rambam Health Care Campus, Haifa, Israel., Mustafa-Hellou M; Internal Medicine Department E, Rambam Health Care Campus, Haifa, Israel., Qasum M; Internal Medicine Department D, Rambam Health Care Campus, Haifa, Israel., Keidar Z; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.; Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel., Paul M; Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Dec 06; Vol. 73 (11), pp. e3859-e3866.
DOI:	10.1093/cid/ciaa929
Abstrakt:	Background: Staphylococcus aureus bacteremia (SAB) is uniquely characterized by focal pyogenic complications that might not be apparent clinically. We investigated the benefit of adding fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the workup of patients with SAB. Methods: In a matched-cohort study patients with SAB (intervention group) were prospectively recruited to undergo FDG-PET/CT 7-14 days after diagnosis. Treatment was directed by FDG-PET/CT findings. Clinical outcomes were compared with a control group of patients with SAB who had not undergone FDG-PET/CT, matched by age, Charlson score, methicillin susceptibility, and survival duration to FDG-PET/CT. The primary outcome was 90-day mortality. Residual confounding was controlled through regression analyses. Results: During the study period 149 patients with 151 separate episodes of SAB underwent FDG-PET/CT and were compared with 150 matched patients with 151 SAB episodes. Patients in the intervention group acquired infections more frequently in the community and had less frequently solid malignancies and more frequently high-risk SAB. Ninety-day mortality in the intervention group was significantly lower than in the control group (21/151 [13.9%] vs 43/151 [28.5%], P = .002). The difference remained significant in a subgroup analysis of patients with community-onset infections without malignancy and among patients with low-risk SAB. Controlling for other risk factors for mortality, FDG-PET/CT performance among all patients was independently associated with lower mortality (OR, .39; 95% CI, .18-.84). Patients in the intervention group had longer duration of treatment and more focus control procedures performed compared with the control group. Conclusions: FDG-PET/CT in patients with SAB seems to improve survival through guidance of treatment duration and co-interventions. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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