18F-FDG PET/CT for the diagnosis and evaluation of antibiotic response in patients with left ventricular assistive device infection: A case report

Abstract

The left ventricular assistive device (LVAD) is critical for end-stage heart failure patients. Centrifugal flow LVAD recipients have a 4-year survival rate of nearly 60%, with infection occurring in over 50% of patients within 2 years. Herein, we report a case of LVAD infection in a 60-year-old man. The patient presented with fever after 49 days following LVAD implantation. Culture of both blood and areas around the outflow cannula indicated an infection with Enterobacter cloacae and Staphylococcus aureus. After sequential treatment with meropenem and daptomycin, as well as abdominal incisional debridement, the patient’s symptoms of fever disappeared, but the inflammatory markers, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, remained abnormal. Five 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans were performed to evaluate the infection. PET/CT revealed infected lesions around the lower segment of the outflow cannula with high FDG uptake. After continuous oral antibiotic treatment for more than 1 year, the infected areas with high FDG uptake around the outflow cannula gradually declined and eventually disappeared, consistent with the noted changes in both ESR and CRP levels in the serum. Multiple continuous 18F-FDG PET/CT scans can distinguish high FDG uptake areas of infection from sterile inflammatory areas, assisting in the accurate diagnosis of infection and evaluation of antibiotic treatment after LVAD implantation.