TY - JOUR
T1 - 18-Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan for monitoring the therapeutic response in experimental Staphylococcus aureus foreign-body osteomyelitis
AU - Chatziioannou, Sofia
AU - Papamichos, Odysseas
AU - Gamaletsou, Maria N.
AU - Georgakopoulos, Alexandros
AU - Kostomitsopoulos, Nikolaos G.
AU - Tseleni-Balafouta, Sofia
AU - Papaparaskevas, Joseph
AU - Walsh, Thomas J.
AU - Pneumaticos, Spiros G.
AU - Sipsas, Nikolaos V.
N1 - Funding Information:
The authors would like to thank Maria Kallergi, PhD, and Dr. Dimitrios Ziogas, MD, for their assistance in the statistical analysis of the data. Dr. Nikolaos V. Sipsas acknowledges support from the Special Account for Research Funds (ELKE) of the National and Kapodistrian University of Athens, Greece. Dr. Thomas J. Walsh is supported in part as a scholar of the Sharp Family Foundation in Pediatric Infectious Diseases and as a scholar in Emerging Infectious Diseases from the Save Our Sick Kids Foundation.
Publisher Copyright:
© 2015 Chatziioannou et al.
PY - 2015/8/27
Y1 - 2015/8/27
N2 - Background: 18-Fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) scan is useful for diagnosis of osteoarticular infections. Whether 18F-FDG PET/CT scanning may be used for therapeutic monitoring is not clear. The objective of this study was to develop 18F-FDG PET/CT scanning for monitoring therapeutic response to antimicrobials in experimental Staphylococcus aureus osteomyelitis. Methods: A total of 22 rabbits were studied. In 20 animals, the right tibia was inoculated intraoperatively with S. aureus. Two control animals were inoculated with normal saline. A needle was placed in the tibia as a foreign body. Infection was allowed to develop for 21 days when 18F-FDG PET/CT was performed, the needle was removed, and bone specimens were cultured to confirm infection. Antimicrobial therapy with daptomycin was initiated in all successfully infected animals for 1, 3, or 6 weeks. Following completion of treatment, a second 18F-FDG PET/CT was performed, animals were euthanized, and infected tibias were harvested for quantitative cultures and histology. A positive scan was defined as 18F-FDG signal activity greater in the infected tibia than that of the contralateral non-infected control tibia. Therapeutic response was measured by the change of 18F-FDG signal activity in the infected tibia. Results: All successfully infected animals (n=14), with microbiologically and/or histologically confirmed osteomyelitis, had positive 18F-FDG PET/CT scans, while the two control animals had negative scans despite the presence of the foreign body [mean maximum standardized uptake value (SUVmax) (±SD) values 2.96 (±0.80) vs. 1 (±1.10), respectively, P=0.04]. In the 14 successfully infected animals, the mean SUVmax was significantly higher in the infected compared to the uninfected tibia (P<0.0001). A SUVmax of 1.4, when used as a cutoff for infection, yielded a diagnostic accuracy of 93 %. At the end of treatment, successfully treated animals and saline controls had a negative 18F-FDG PET/CT scan (n=4), while animals with persistent infection despite treatment (n=12) had a positive 18F-FDG PET/CT scan (SUVmax 1.0-3.0) (p<0.001). SUVmax values were significantly reduced after 42 days of treatment from 3.15±0.5 (day 7) to 1.71±0.37 (day 42) (p=0.05). Conclusions:18F-FDG PET/CT scan is a sensitive and specific tool in therapeutic monitoring of experimental foreign-body osteomyelitis.
AB - Background: 18-Fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) scan is useful for diagnosis of osteoarticular infections. Whether 18F-FDG PET/CT scanning may be used for therapeutic monitoring is not clear. The objective of this study was to develop 18F-FDG PET/CT scanning for monitoring therapeutic response to antimicrobials in experimental Staphylococcus aureus osteomyelitis. Methods: A total of 22 rabbits were studied. In 20 animals, the right tibia was inoculated intraoperatively with S. aureus. Two control animals were inoculated with normal saline. A needle was placed in the tibia as a foreign body. Infection was allowed to develop for 21 days when 18F-FDG PET/CT was performed, the needle was removed, and bone specimens were cultured to confirm infection. Antimicrobial therapy with daptomycin was initiated in all successfully infected animals for 1, 3, or 6 weeks. Following completion of treatment, a second 18F-FDG PET/CT was performed, animals were euthanized, and infected tibias were harvested for quantitative cultures and histology. A positive scan was defined as 18F-FDG signal activity greater in the infected tibia than that of the contralateral non-infected control tibia. Therapeutic response was measured by the change of 18F-FDG signal activity in the infected tibia. Results: All successfully infected animals (n=14), with microbiologically and/or histologically confirmed osteomyelitis, had positive 18F-FDG PET/CT scans, while the two control animals had negative scans despite the presence of the foreign body [mean maximum standardized uptake value (SUVmax) (±SD) values 2.96 (±0.80) vs. 1 (±1.10), respectively, P=0.04]. In the 14 successfully infected animals, the mean SUVmax was significantly higher in the infected compared to the uninfected tibia (P<0.0001). A SUVmax of 1.4, when used as a cutoff for infection, yielded a diagnostic accuracy of 93 %. At the end of treatment, successfully treated animals and saline controls had a negative 18F-FDG PET/CT scan (n=4), while animals with persistent infection despite treatment (n=12) had a positive 18F-FDG PET/CT scan (SUVmax 1.0-3.0) (p<0.001). SUVmax values were significantly reduced after 42 days of treatment from 3.15±0.5 (day 7) to 1.71±0.37 (day 42) (p=0.05). Conclusions:18F-FDG PET/CT scan is a sensitive and specific tool in therapeutic monitoring of experimental foreign-body osteomyelitis.
KW - <sup>18</sup>F-FDG PET/CT
KW - Daptomycin
KW - Experimental osteomyelitis
KW - Staphylococcus aureus
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U2 - 10.1186/s13018-015-0274-9
DO - 10.1186/s13018-015-0274-9
M3 - Article
C2 - 26306506
AN - SCOPUS:84940212791
SN - 1749-799X
VL - 10
JO - Journal of Orthopaedic Surgery and Research
JF - Journal of Orthopaedic Surgery and Research
IS - 1
M1 - 132
ER -