18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia

The timely detection of metastatic infectious foci in gram-positive bacteremia is crucial, because these foci often require prolonged antibiotic treatment or drainage. The diagnosis of metastatic infectious foci is difficult because localizing symptoms are often absent. We investigated whether 18F-FDG PET/CT was able to detect such foci and whether detection influenced clinical out-come. Methods: One hundred fifteen nonneutropenic patients with gram-positive bacteremia were prospectively included. Patients with positive blood cultures growingStaphylococcus aur-eus, Streptococcus species, or Enterococcus species were eligi-ble when a risk factor for developingmetastatic infectious fociwas present. 18F-FDGPET/CTwas performedwithin 2wkafter the first positive blood culture. Abnormal 18F-FDG uptake had to be con-firmed by radiologic, microbiologic, or pathologic studies. Results were compared with a matched historical control group of 23