Impact of [18F] FDG PET/CT on outcomes in patients with Staphylococcus aureus bacteremia: A retrospective single-center experience.

Objective: Staphylococcus aureus bacteremia (SAB) is a leading cause of community and hospital-acquired bacteremia with significant morbidity and mortality. Effective management depends on accurate diagnosis, source control and assessment of metastatic infections. [¹⁸F] FDG PET/CT has been shown to reduce mortality in high-risk SAB patients. This study aims to evaluate the impact of [¹⁸F] FDG PET/CT on outcomes in patients with SAB.

Methods: Single-center, retrospective, real-life setting study including all consecutive SAB cases from 2017 to 2019. Medical records were analyzed to collect information.

Results: Out of the 315 included patients, 132 underwent [¹⁸F] FDG PET/CT. In those patients, a clear focus of infection was more frequently identified, leading to better adapted treatments and extended hospital stays. Overall mortality rates at 30 days, 90 days and one year were 25.1 %, 36.8 % and 44.8 % respectively. Mortality was significantly lower in the [¹⁸F] FDG PET/CT group (p < 0.0001) and persisted (p < 0.05) after adjusting for imbalances between groups regarding oncologic patients and deaths within 7 days. The difference in mortality remained significant irrespective of prolonged bacteremia but was not significant with regard to hospital-acquired SAB. Supplementary analysis using the Cox proportional hazards model confirmed that [¹⁸F] FDG PET/CT was significantly associated with reduced mortality (p < 0.05).

Conclusion: In this real-life cohort, patients with SAB having undergone [¹⁸F] FDG PET/CT experienced lower mortality rates, highlighting the additional value of [¹⁸F] FDG PET/CT in SAB management. Further research is needed to identify the subpopulations that would benefit most from the integration of [¹⁸F] FDG PET/CT in their work-up.