Metastatic infection is an important complication of Staphylococcus aureus bacteremia (SAB). Early diagnosis of metastatic infection is crucial, because specific treatment is required. However, metastatic infection can be asymptomatic and difficult to detect. In this study, we investigated the role of ¹⁸F-FDG PET/CT in patients with SAB for detection of metastatic infection and its consequences for treatment and outcome. Methods: All patients with SAB at Radboud University Medical Center were included between January 2013 and April 2016. Clinical data and results of ¹⁸F-FDG PET/CT and other imaging techniques, including echocardiography, were collected. Primary outcomes were newly diagnosed metastatic infection by ¹⁸F-FDG PET/CT, subsequent treatment modifications, and patient outcome. Results: A total of 184 patients were included, and ¹⁸F-FDG PET/CT was performed in 105 patients, of whom 99 had a high-risk bacteremia. ¹⁸F-FDG PET/CT detected metastatic infectious foci in 73.7% of these high-risk patients. In 71.2% of patients with metastatic infection, no signs and symptoms suggesting metastatic complications were present before ¹⁸F-FDG PET/CT was performed. ¹⁸F-FDG PET/CT led to a total of 104 treatment modifications in 74 patients. Three-month mortality was higher in high-risk bacteremia patients without ¹⁸F-FDG PET/CT performed than in those in whom ¹⁸F-FDG PET/CT was performed (32.7% vs. 12.4%, P = 0.003). In multivariate analysis, ¹⁸F-FDG PET/CT was the only factor independently associated with reduced mortality (P = 0.005; odds ratio, 0.204; 95% confidence interval, 0.066–0.624). A higher comorbidity score was independently associated with increased mortality (P = 0.003; odds ratio, 1.254; 95% confidence interval, 1.078–1.457). Conclusion: ¹⁸F-FDG PET/CT is a valuable technique for early detection of metastatic infectious foci, often leading to treatment modification. Performing ¹⁸F-FDG PET/CT is associated with significantly reduced 3-mo mortality.

转移性感染是金黄色葡萄球菌菌血症（SAB）的重要并发症。转移性感染的早期诊断至关重要，因为需要特定的治疗方法。但是，转移性感染可能是无症状的并且难以检测。在这项研究中，我们调查了¹⁸ F-FDG PET / CT在SAB患者中检测转移性感染及其对治疗和后果的影响。方法：纳入2013年1月至2016年4月在Radboud大学医学中心的所有SAB患者。收集^18项F-FDG PET / CT和其他影像技术（包括超声心动图）的临床数据和结果。主要结果是新诊断为转移性感染的患者^18岁F-FDG PET / CT，后续治疗修改和患者预后。结果：共纳入184例患者，在105例患者中进行了^18次F-FDG PET / CT，其中99例具有高危菌血症。在这些高危患者中，有^18个F-FDG PET / CT检测出转移感染灶。在进行转移性感染的患者中，有71.2％的患者在进行¹⁸ F-FDG PET / CT之前没有任何迹象和症状表明存在转移性并发症。¹⁸ F-FDG PET / CT对74例患者进行了104例治疗修改。没有进行¹⁸ F-FDG PET / CT的高危菌血症患者的三个月死亡率高于^18例进行F-FDG PET / CT（32.7％vs. 12.4％，P = 0.003）。在多变量分析中，¹⁸ F-FDG PET / CT是与死亡率降低独立相关的唯一因素（P = 0.005；优势比为0.204； 95％置信区间为0.066-0.624）。较高的合并症评分与死亡率增加独立相关（P = 0.003；优势比为1.254； 95％置信区间为1.078-1.457）。结论： ¹⁸ F-FDG PET / CT是早期发现转移性感染灶的有价值的技术，通常会导致治疗方法的改变。进行¹⁸ F-FDG PET / CT可显着降低3个月死亡率。