Use of whole body PET scan in patients with infective endocarditis may impact care of those with intravascular devices: results from a comparative retrospective cohort study.

Background: Whole body 18F-fluorodeoxyglucose positron emission tomography/CT (WBP) may be an important tool for the management of infective endocarditis (IE) by identifying areas of occult primary or metastatic infection. However, the optimal use of this study in patients with IE is unknown.

Objectives: Compare clinical characteristics and outcomes in patients who did and did not have WBP as part of their endocarditis management, and describe the impact that WBP has on the management of IE.

Design: Retrospective cohort study.

Methods: We performed a protocolized chart review of hospitalized patients with suspected IE who were discussed by a multidisciplinary endocarditis team at a tertiary care center between June 2018 and January 2022.

Results: Among 427 patients, there were 114 patients (26.7%) in the WBP group and 313 patients (73.3%) in the non-WBP group. The WBP group was significantly more likely to have end-stage renal disease, intracardiac prostheses, and cardiac devices, while the non-WBP group was more likely to have flail leaflet or paravalvular abscesses. There were no statistically significant differences in mortality, hospital readmission, or length of stay between the two cohorts. The WBP group was more likely to receive longer antibiotic courses and had higher rates of suppressive antibiotics following treatment courses (p < 0.001). The use of WBP directly affected management in 44.6% of those patients, especially when performed to evaluate intravascular prostheses and grafts. Changes in management included further workup, performance of a source control procedure, or a change in the antibiotic regimen.

Conclusion: WBP plays an important role in identifying metastatic foci of infection and directly impacting the management of patients with confirmed or suspected endocarditis. Infected intravascular prostheses were effectively identified via WBP, and as a result, these patients were prescribed longer courses of antibiotics and suppressive antibiotics.