Value of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Identifying Osteoarticular Septic Grafts in Suspected Infective Endocarditis: Results from a Large Monocentric Cohort
<p>Flowchart of the study.</p> "> Figure 2
<p>Sternoclavicular and spine OASGs detected by FDG-PET/CT. (<b>A</b>,<b>B</b>): Arthritis of the left sternoclavicular joint (white arrow; (<b>A</b>): coronal section, (<b>B</b>): axial section); (<b>C</b>): spondylodiscitis at the L4–L5 level (white star).</p> ">
Abstract
:1. What Is Already Known on This Topic
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- Infective endocarditis (IE) may sometimes be revealed by extra-cardiac manifestations, such as osteoarticular septic grafts (OASGs), which are related to hematogenous bacterial migration.
2. What This Study Adds
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- Over 25% of patients hospitalized for suspected IE had OASGs according to FDG-PET/CT data, mainly localized in the spine and asymptomatic in almost 50% of cases.
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- OASGs were associated with tricuspid infection and musculoskeletal pain. There was also a trend towards an association with sustained bacteremia.
3. How This Study Might Affect Research, Practice, or Policy
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- Based on the 2023 European Society of Cardiology guidelines suggesting that PET-FDG/CT could be considered for screening peripheral lesions in asymptomatic patients, the findings of this exam could be particularly useful in patients with tricuspid endocarditis or a sustained bacteremia to detect asymptomatic OASGs.
4. Introduction
5. Material and Methods
5.1. Population
5.2. Study Endpoints
5.3. Reading and Interpretation of FDG-PET/CT Images
5.4. Statistical Analysis
6. Results
6.1. Description of the Population
6.2. Predictors of Osteoarticular Septic Grafting
7. Discussion
8. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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% (n) or Mean ± SD | |
---|---|
Age, years | 72.3 ± 13.1 |
Sex (male) | 66.7 (116) |
Diabetes mellitus | 31.6 (55) |
Hypertension | 66.7 (116) |
BMI | 25.67 ± 5.7 |
Obesity | 17.9 (31) |
Immunodepression | 41.4 (72) |
Cancer | 20.1 (35) |
IV drug addiction | 1.1 (2) |
Cardiovascular condition | |
Heart disease | 37.4 (65) |
Native valve | 46.6 (81) |
Prosthetic valve | 53.4 (93) |
Biologic | 37.4 (65) |
Mechanical | 14.4 (25) |
Missing data | 1.7 (3) |
Characteristics of infection | |
Definite or possible endocarditis | 85.6 (149) |
Endocarditis certainty according to Duke criteria (n = 149) | |
Definite | 63.2 (110) |
Possible | 22.4 (39) |
Rejected | 14.4 (25) |
Bacteremia without endocarditis | 14.4 (25) |
Location of endocarditis (n = 149) | |
Left heart | 73.2 (109) |
Aortic | 52.3 (78) |
Mitral | 24.8 (37) |
Right heart | 6.7 (10) |
Pulmonary | 0 (0) |
Tricuspid | 5.2 (9) |
Missing data | 0.7 (1) |
Pacemaker | 25.5 (38) |
Implantable cardioverter defibrillator | 8.1 (12) |
Clinical data | |
Musculoskeletal pain | 19.7 (34) |
Fever | 81.5 (141) |
Laboratory analysis | |
C-reactive protein (mg/L) | 95.0 ± 81.5 |
Hyperleukocytosis | 45.4 (79) |
Microbiological data | |
Positive blood cultures | 84.5 (147) |
All cocci infection | 79.3 (138) |
All Staphylococcus species | 32.8 (57) |
S. aureus | 21.3 (37) |
S. epidermidis | 5.7 (10) |
Other Staphylococcus species | 5.7 (10) |
All Streptococcus species | 25.9 (45) |
S. gallolyticus | 6.9 (12) |
Gram-negative bacillus infection | 14.4 (25) |
Enterococcus faecalis | 18.9 (33) |
Other bacterial infection | 16.1 (28) |
Unknown bacterial infection | 7.5 (13) |
Portal of entry | |
Skin | 20.2 (35) |
Dental | 8.1 (14) |
Articular | 2.3 (4) |
Unknown | 45.7 (79) |
Digestive | 15.6 (27) |
Urologic | 4.0 (7) |
Ear, nose, and throat | 2.3 (4) |
OASG | 27.6 (48) |
Spine | 12.1 (21) |
Sternoclavicular | 4.0 (7) |
Coxofemoral | 5.2 (9) |
Glenohumeral | 5.2 (9) |
Sacroiliac | 1.1 (2) |
Severity/complications | |
Length of hospitalization | 23.8 ± 17.6 |
Death | 16.2 (28) |
Transfer to intensive care unit | 36.4 (63) |
Relapse | 2.9 (5) |
OASG+ % (n) or Mean ± SD n = 48 | OASG− % (n) or Mean ± SD n = 126 | OR (95% CI) | p-Value | |
---|---|---|---|---|
Age | 74.08 ± 12.9 | 71.4 ± 13.0 | 1.00 (1.00–1.01) | 0.151 |
Sex (male) | 56.0 (27) | 70.6 (89) | 0.88 (0.76–1.01) | 0.073 |
Hypertension | 70.0 (34) | 65.1 (82) | 1.05 (0.91–1.21) | 0.475 |
Diabetes mellitus | 20.0 (10) | 35.7 (45) | 0.88 (0.76–1.01) | 0.060 |
BMI (kg/m2) | 26.0 ± 6.0 | 25.3 ± 5.4 | 1.01 (1.00–1.02) | 0.155 |
Obesity | 27.0 (13) | 14.4 (18) | 1.19 (1.00–1.41) | 0.052 |
Cancer | 22.0 (11) | 19.1 (24) | 1.05 (0.89–1.24) | 0.572 |
Immunodepression | 41.0 (20) | 41.3 (52) | 1.00 (0.88–1.15) | 0.962 |
Pre-existing cardiac disease | 35.0 (17) | 38.1 (48) | 0.98 (0.85–1.12) | 0.746 |
Musculoskeletal pain | 43.0 (21) | 10.4 (13) | 1.53 (1.31–1.79) | <0.0001 |
Fever | 81.0 (39) | 81.6 (102) | 1.00 (0.84–1.18) | 0.958 |
Confirmed IE | 85.0 (41) | 85.7 (108) | 1.00 (0.82–1.20) | 0.960 |
Definite IE | 64.0 (31) | 62.7 (79) | 1.02 (0.89–1.17) | 0.819 |
Possible IE | 20.0 (10) | 23.0 (29) | 0.98 (0.83–1.15) | 0.759 |
Rejected IE | 14.0 (7) | 14.3 (18) | 1.00 (0.83–1.22) | 0.960 |
Left heart | 58.0 (28) | 64.3 (81) | 0.95 (0.83–1.09) | 0.471 |
Aortic | 43.0 (21) | 45.2 (57) | 0.99 (0.86–1.13) | 0.861 |
Mitral | 18.8 (9) | 22.2 (28) | 0.96 (0.82–1.13) | 0.619 |
Tricuspid | 14.6 (7) | 1.6 (2) | 1.70 (1.27–2.27) | 0.0005 |
PM or ICD | 31.3 (15) | 27.8 (35) | 1.03 (0.89–1.20) | 0.653 |
Native valve | 50.0 (24) | 45.2 (57) | 1.04 (0.91–1.19) | 0.576 |
Prosthetic valve | 50.0 (24) | 54.8 (69) | 0.96 (0.84–1.10) | 0.576 |
Biologic | 41.7 (20) | 35.7 (45) | 1.05 (0.92–1.21) | 0.471 |
Mechanical | 8.3 (4) | 19.0 (24) | 0.83 (0.69–1.01) | 0.060 |
Portal of entry | ||||
Articular | 6.4 (3) | 0.8 (1) | 1.63 (1.05–2.53) | 0.023 |
Skin | 19.2 (9) | 20.6 (26) | 0.98 (0.83–1.16) | 0.830 |
Dental | 6.4 (3) | 8.7 (11) | 0.94 (0.74–1.20) | 0.617 |
Digestive | 21.3 (10) | 13.5 (17) | 1.12 (0.94–1.35) | 0.212 |
Ear, nose, and throat | 0 | 3.2 (4) | 0.75 (0.49–1.18) | 0.219 |
Urological | 2.1 (1) | 4.8 (6) | 0.87 (0.62–1.23) | 0.437 |
Main bacterial species | ||||
All cocci infection | 85.4 (41) | 77.0 (97) | 1.11 (0.94–1.31) | 0.222 |
All Staphylococcus species | 43.8 (21) | 28.6 (36) | 1.15 (1.00–1.32) | 0.057 |
S. aureus | 31.3 (15) | 17.5 (22) | 1.18 (1.00–1.39) | 0.047 |
S. epidermidis | 4.2 (2) | 6.4 (8) | 0.92 (0.69–1.23) | 0.583 |
All Streptococcus species infection | 22.9 (11) | 27.0 (34) | 0.96 (0.82–1.12) | 0.586 |
S. galloliticcus | 8.3 (4) | 6.4 (8) | 1.06 (0.82–1.38) | 0.647 |
Enterococcus faecalis | 16.7 (8) | 19.8 (25) | 0.81 (0.32–1.79) | 0.633 |
All bacilli infection | 12.5 (6) | 15.1 (19) | 0.96 (0.79–1.16) | 0.667 |
Escherichia coli | 4.2 (2) | 0.8 (1) | 1.49 (0.89–2.48) | 0.128 |
Other bacteria | 14.6 (7) | 16.7 (21) | 0.97 (0.81–1.16) | 0.740 |
No bacteria | 4.2 (2) | 8.7 (11) | 1.11 (0.93–1.34) | 0.254 |
Positive blood cultures | 89.6 (43) | 82.5 (104) | 1.17 (1.04–1.31) | 0.011 |
Number of blood cultures | 5 ± 5.3 | 3.0 ± 3.0 | 1.03 (1.01–1.05) | 0.002 |
Duration of positivity | 101.3 ± 104.9 | 63.1 ± 71.2 | 1.00 (1.00–1.00) | 0.015 |
Hyperleukocytosis | 60.4 (29) | 39.7 (50) | 1.18 (1.04–1.35) | 0.014 |
C-reactive protein (mg/L) | 110.0 ± 102.9 | 89.3 ± 71.4 | 1.00 (1.00–1.00) | 0.135 |
aOR (95% CI) | p-Value | |
---|---|---|
Sex (male) | 0.95 (0.84–1.38) | 0.472 |
Age | 1.00 (1.00–1.01) | 0.328 |
Articular portal of entry | 1.27 (0.86–1.89) | 0.228 |
Hyperleukocytosis | 1.12 (1.00–1.27) | 0.059 |
Diabetes mellitus | 0.90 (0.79–1.02) | 0.100 |
Obesity | 1.15 (0.97–1.36) | 0.110 |
Musculoskeletal pain | 1.42 (1.23–1.65) | <0.0001 |
Tricuspid valve | 1.51 (1.16–1.97) | 0.002 |
Mechanical prosthetic valve | 0.88 (0.74–1.05) | 0.159 |
Staphylococcus aureus infection | 1.04 (0.89–1.22) | 0.581 |
Number of positive blood cultures | 1.02 (1.00–1.04) | 0.053 |
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Luczak, C.; Lerman, L.; Pina Vegas, L.; Emsen, B.; Hugues, B.; Lepeule, R.; Ternacle, J.; Huguet, R.; Lim, P.; Decousser, J.-W.; et al. Value of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Identifying Osteoarticular Septic Grafts in Suspected Infective Endocarditis: Results from a Large Monocentric Cohort. J. Clin. Med. 2024, 13, 5419. https://doi.org/10.3390/jcm13185419
Luczak C, Lerman L, Pina Vegas L, Emsen B, Hugues B, Lepeule R, Ternacle J, Huguet R, Lim P, Decousser J-W, et al. Value of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Identifying Osteoarticular Septic Grafts in Suspected Infective Endocarditis: Results from a Large Monocentric Cohort. Journal of Clinical Medicine. 2024; 13(18):5419. https://doi.org/10.3390/jcm13185419
Chicago/Turabian StyleLuczak, Cédric, Lionel Lerman, Laura Pina Vegas, Berivan Emsen, Benjamin Hugues, Raphaël Lepeule, Julien Ternacle, Raphaëlle Huguet, Pascal Lim, Jean-Winoc Decousser, and et al. 2024. "Value of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Identifying Osteoarticular Septic Grafts in Suspected Infective Endocarditis: Results from a Large Monocentric Cohort" Journal of Clinical Medicine 13, no. 18: 5419. https://doi.org/10.3390/jcm13185419