Access, knowledge and experience with fluorodeoxyglucose positron emission tomography/computed tomography in infection management: a survey of Australia and New Zealand infectious diseases physicians and microbiologists

Douglas, Abby; Thursky, Karin; Worth, Leon J; Harrison, Simon; Hicks, Rodney J.; Slavin, Monica

doi:10.1111/imj.14117

Cited by 8 publications

(7 citation statements)

References 13 publications

(27 reference statements)

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“…Experience of participants in the use of 18 F-FDG PET-CT Despite the availability of 18 F-FDG PET-CT among the respondents, slightly more than half used it regularly for infection management, but only 17% speci cally for IFI management, compared to a widespread use in Oncology indications. This results are similar to those of a European survey on the treatment of invasive aspergillosis [24] and the Australian survey [19].…”

Section: Staging (Dissemination/endocarditis)supporting

confidence: 89%

“…Despite data from several studies increasingly supporting the usefulness of 18 F-FDG PET-CT for the management of infection in immunocompromised patients [2,5,[16][17][18], practitioners encountered barriers such as disagreement regarding the indication and, in some cases, lack of reimbursement. Likewise, a survey conducted in Australia obtained similar results regarding access to 18 F-FDG PET-CT for the management of infection [19] in spite of the clinicians considering it useful. Costeffectiveness studies are needed to clarify the role of 18 F-FDG PET-CT as compared to conventional imaging to overcome these limitations.…”

Section: Demographics and Access To 18 F-fdg Pet/ctmentioning

confidence: 79%

See 1 more Smart Citation

What Do We Know About the Usefulness of 18f-fdg Pet-ct for the Management of Invasive Fungal Infection? An International Survey.

Gutiérrez-Villanueva,

Calderón-Parra,

Diaz

et al. 2024

Preprint

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Background Recent data support 18F-FDG PET-CT for the management of infections in immunocompromised patients, including invasive fungal infection (IFI). However, its role is not well established in clinical practice. We performed an international survey to evaluate the knowledge of physicians about the usefulness of 18F-FDG PET-CT in IFI, in order to define areas of uncertainty. Methods An online survey was distributed to infectious diseases working groups in December 2023-January 2024. It included questions regarding access to 18F-FDG PET-CT, knowledge on its usefulness for IFI and experience of the respondents. A descriptive analysis was performed. Results 180 respondents answered; 60.5% were Infectious Diseases specialists mainly from Spain (52.8%) and Italy (23.3%). 84.4% had access to 18F-FDG PET-CT at their own center. 85.6% considered that 18F-FDG PET-CT could be better than conventional tests for IFI. In the context of IFI risk, 81.1% would consider performing 18F-FDG PET-CT to study fever without a source and around 50% to evaluate silent lesions and assess response, including distinguishing residual from active lesions. Based on the results of the follow-up 18F-FDG PET-CT, 56.7% would adjust antifungal therapy duration. 60% would consider a change in the diagnostic or therapeutic strategy in case of increased uptake or new lesions. Uncovering occult lesions (52%) and diagnosing/excluding endocarditis (52.7%) were the situations in which 18F-FDG PET-CT was considered to have the most added value. Conclusion Although the majority considered that 18F-FDG PET-CT may be useful for IFI, many areas of uncertainty remain: timing and indication in which it adds most value, duration of uptake, the threshold for discontinuing treatment or the influence of immune status. There is a need for protocolized research to improve IFI management.

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Section: Staging (Dissemination/endocarditis)supporting

confidence: 89%

Section: Demographics and Access To 18 F-fdg Pet/ctmentioning

confidence: 79%

What Do We Know About the Usefulness of 18f-fdg Pet-ct for the Management of Invasive Fungal Infection? An International Survey.

Gutiérrez-Villanueva,

Calderón-Parra,

Diaz

et al. 2024

Preprint

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“…Conversely, the longer half‐life of Ga‐67 allows delayed imaging, with better clearance of background activity and more specific binding; however, this is at the expense of a high radiation dose to patients, and a long delay in results availability, which is a significant disadvantage in the clinical management of unwell patients with suspected serious infections. In this context, FDG PET–CT is now emerging as a very promising tool for PUO, prolonged neutropenic fever and prosthetic device infection, but the lack of funding in Australia significantly limits its availability …”

Section: Discussionmentioning

confidence: 99%

Comparison between gallium‐68 citrate positron emission tomography‐computed tomography and gallium‐67 citrate scintigraphy for infection imaging

Segard

Morandeau

Dunne

et al. 2019

Internal Medicine Journal

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Background Preliminary studies have reported promising results for the utility of gallium‐68 (Ga‐68) citrate positron emission tomography‐computed tomography (PET–CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the ‘gold standard’ nuclear imaging technique: gallium‐67 (Ga‐67) citrate scintigraphy. Aims To compare the two imaging modalities to ascertain whether Ga‐68 citrate PET–CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Methods Patients with PUO and suspected bone or joint infection underwent Ga‐67 citrate scintigraphy and Ga‐68 citrate PET–CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. Results 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga‐67 citrate scintigraphy and 69% for Ga‐68 citrate PET–CT, a specificity of 79% for Ga‐67 citrate and 67% for Ga‐68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga‐68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. Conclusion The sensitivity and specificity of Ga‐68 citrate PET–CT were found to be consistently lower than Ga‐67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga‐68 citrate PET–CT, this modality could not currently be recommended to replace Ga‐67 citrate scintigraphy for routine clinical use.

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“…However, the data to support the utility of 18F‐FDG‐PET/CT for the diagnosis of IA stem from retrospective and non‐randomised prospective studies, with results from larger prospective studies still pending ( Moderate recommendation, Level II evidence ). Furthermore, access to PET/CT may be limited and is not currently funded in Australia for any infection indications 69 …”

Section: Question 3: How Has Thoracic Imaging and Other Types Of Imaging In Ia Improved?mentioning

confidence: 99%

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Douglas

Smibert

Bajel

et al. 2021

Internal Medicine Journal

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Invasive aspergillosis (IA) in haematology/oncology patients presents as primary infection or breakthrough infection, which can become refractory to antifungal treatment and has a high associated mortality. Other emerging patient risk groups include patients in the intensive care setting with severe respiratory viral infections, including COVID‐19. These guidelines present key diagnostic and treatment recommendations in light of advances in knowledge since the previous guidelines in 2014. Culture and histological‐based methods remain central to the diagnosis of IA. There is increasing evidence for the utility of non‐culture methods employing fungal biomarkers in pre‐emptive screening for infection, as well as for IA diagnosis when used in combination. Although azole resistance appears to be uncommon in Australia, susceptibility testing of clinical Aspergillus fumigatus complex isolates is recommended. Voriconazole remains the preferred first‐line antifungal agent for treating primary IA, including for extrapulmonary disease. Recommendations for paediatric treatment broadly follow those for adults. For breakthrough and refractory IA, a change in class of antifungal agent is strongly recommended, and agents under clinical trial may need to be considered. Newer immunological‐based imaging modalities warrant further study, while surveillance for IA and antifungal resistance remain essential to informing the relevance of current treatment recommendations.

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Access, knowledge and experience with fluorodeoxyglucose positron emission tomography/computed tomography in infection management: a survey of Australia and New Zealand infectious diseases physicians and microbiologists

Abstract: Access to FDG-PET/CT in Australia and New Zealand is modest and is limited by lack of reimbursement for infection indications. There is discrepancy between recognised ID indications for FDG-PET/CT and funded indications. This article is protected by copyright. All rights reserved.

Cited by 8 publications

References 13 publications

What Do We Know About the Usefulness of 18f-fdg Pet-ct for the Management of Invasive Fungal Infection? An International Survey.

What Do We Know About the Usefulness of 18f-fdg Pet-ct for the Management of Invasive Fungal Infection? An International Survey.

Comparison between gallium‐68 citrate positron emission tomography‐computed tomography and gallium‐67 citrate scintigraphy for infection imaging

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

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