Table 2.
Infection focus found on FDG-PET/CT and treatment modification
| Infection focus | Total | New focus | Suspected focus | Treatment modification |
|---|---|---|---|---|
| Pneumonia | 5 | 4 | 1 |
Patient 1. A diagnostic puncture of a PET-positive septic embolus at the left acetabulum was performed. Treatment with liposomal amphotericin B and voriconazole was continued Patient 2: Treatment with caspofungin was continued until repeat FDG-PET/CT showed no signs of pulmonary infection 6 weeks later Patient 3: This patient already received vancomycin, but due to pathologic pulmonary FDG uptake cotrimoxazole was added for better pulmonary penetration Patient 4: This patient already received ceftazidime, but after FDG-PET/CT showed hospital-acquired pneumonia tobramycin was additionally started |
| Septic arthritis | 4 | 1 | 3 |
Patient 1: Surgical washout of the left hip was performed, flucloxacillin dosage of 12 g/24 h was increased to 16 g/24 h intravenously Patient 2: Surgical washout of the right shoulder and left hip was performed. Treatment with flucloxacillin 12 g/24 h was continued |
| Aspergilloma | 1 | 1 | 0 | Patient 1: Treatment with Amphotericin B and voriconazole was started |
| Infection obturator internus | 1a | 1a | 0 | Patient 1. The obturator internus muscle of the right leg was surgically explored and washed out |
| Endocarditis | 1 | 0 | 1 | No changes in clinical management |
| Generalized candidiasis | 1 | 1 | 0 | Patient 1. A diagnostic puncture of a PET-positive lesion of the thyroid gland was performed. Treatment with liposomal amphotericin B and voriconazole was continued |
| Sinusitis | 1 | 1 | 0 | Patient 1: After FDG-PET/CT saline irrigation (of the maxillary sinus) was started 4 to 6 times per day. The patient already received vancomycin and ceftriaxone |
| Parotitis | 1 | 0 | 1 | No changes in clinical management |
| Sclerosing peritonitis | 1 | 0 | 1 | Patient 1: Because no other infection focus than sclerosing peritonitis was found on FDG-PET/CT, relaparotomy with abdominal washout was performed |
| Abdominal abscess | 1 | 0 | 1 | No changes in clinical management |
| Infected hepatic fluid collection | 1 | 1 | 0 | Patient 1: the fluid collection was drained. Flucloxacilline 12 g/24 h intravenously was supposed to be continued for 6 weeks instead of 2 weeks. However, the patient died after 4 weeks of treatment |
| Infected venous access port | 1 | 1 | 0 | Patient 1. Treatment with flucloxacillin 6.7 g/24 h (pediatric dose) was prolonged to 6 weeks because of multiple septic emboli. Clindamycin was added for better pulmonary penetration to treat the pulmonary septic emboli |
| Septic thrombophlebitis | 1 | 0 | 1 | No changes in clinical management |
| Pancreatitis | 1 | 0 | 1 | Patient 1: After surgical removal of a pancreatic pseudocyst due to trauma, FDG-PET/CT confirmed pancreatic infection for which relaparotomy and abdominal washout were performed |
| No focus found | 9b | n/a | n/a | Patient 1. In one patient, no focus was found but increased FDG uptake of the pancreas was noticed. For this reason, FDG-PET/CT was repeated 6 weeks later, which showed normalized pancreatic uptake |
aOn biopsy, no micro-organism was cultured, and a diagnosis of myositis ossificans was made. Therefore, the FDG-PET/CT result was false positive
bIn two patients, FDG-PET/CT results were false negative. One patient was diagnosed with pneumonia (before FDG-PET/CT based on thoracic X-ray and clinical picture), and one patient was diagnosed with endocarditis (proven at autopsy)