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Objective:To explore the diagnostic value of 18F-deoxyglucose (FDG) PET/CT dual-time-point imaging (DTPI) in the diagnosis of aortic grafts infection (AGI). Methods:Forty-two patients with suspected AGI were prospectively recruited in this DTPI study from October 2014 to October 2021. There were 35(83%) males and 7 females, mean age (54±15) years old, range 22-79 years old. PET/CT image quality was scored as 5 grading scale. Semi-quantitative analysis of DTPI data was performed using maximum standardized uptake value (SUVmax) of suspected AGI lesions. The percentage of SUVmax change between initial and delayed images were recorded as retention index (RI). Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used as the diagnostic reference criteria for AGI.Results:According to the MAGIC criteria, 27 patients (64%) were positive for AGI, and 15 patients (36%) were negative. The mean RI of AGI was higher than that of non-AGI ones[(26.7±18.9)% vs. (6.4 ±18.8)%, P<0.01]. The sensitivity, specificity, and accuracy of initial SUVmax ≥6 with the presence of AGI was 88.9%, 73.3%, and 83.3%, respectively. Delayed SUVmax ≥6 improved the sensitivity (96.3%) and accuracy (88.1%) for diagnosing AGI. DTPI with 15% increment as the optimal cut-off value of RI improved the specificity (93.3%) and accuracy (90.5%) for diagnosing AGI. Fifteen (56%, 15/27) AGI patients had improved image quality grading on the delayed images, leading to more accurately delineating the detailed extent of the infected aortic graft. Conclusion:18F-FDG PET/CT DTPI has better diagnostic performance for AGI than conventional Single-time-point PET/CT imaging by improving image quality as well as enhancing delineation of infected aortic graft extent.
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Objective To analyze the clinical features,etiology and prognostic factors of nosocomial candidemia in Beijing Anzhen Hospital.Methods A total of 174 cases of nosocomial candidemia identified during the period from January 2003 to December 2013 in Anzhen Hospital were reviewed retrospectively.The underlying conditions,risk factors,clinical manifestations and outcome were described and analyzed.The prognostic factors were analyzed by both univariate analysis including t-test and Chisquare test,and multivariate regression analysis.Results The 174 patients included 108 (62.1％) males and 66 (37.9％) females.The mean age of patients was 53.9±27.3 years,specifically:＜18 years (31/174,17.8％),18-＜ 65 years (56/174,32.2％),and ≥ 65 years (87/174,50.0％).About one-third (59/174,33.9％) of the patients were treated in ICU,followed by cardiac surgery ward (58/174,33.3％),respiratory medicine ward (21 / 174,12.1％),general surgery ward (14/174,8.0％),neurology ward (7/174,4.0％),vascular surgery (6/174,3.4％),and orthopedic ward (3/174,1.7％).Fever was documented in all cases,including 37.5-37.9 ℃ in 3 (1.7％) cases,38.0-38.9 ℃ in 81 (46.6％) cases,39.0-39.9 ℃ in 85 (48.9％) cases,and ≥ 40.0 ℃ in 5 (2.9％) cases.Increased peripheral blood WBC (＞10×109/L) was reported in 162 (93.1％) cases.The percentage of neutrophils (＞75％) was reported in 166 (95.4％) cases.Thrombocytopenia (＜ 100 × 109/ L) was documented in 24 (13.8％) cases.The most frequently isolated pathogen was C.albicans (99/174,56.9％),followed by C.parapsilosis (37/174,21.3％),C.glabrata (20/174,11.5％),C.krusei (11/174,6.3％),C.tropicalis (4/174,2.3％),and other Candida spp.(3/174,1.7％).The death rate was 50.0％ (87/174).Univariate analysis showed that old age,thrombocytopenia,hypoalbuminemia,renal insufficiency,indwelling urinary catheter were associated with death of candidemia patients.Multivariate analysis showed that hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter were independent risk factors of death in nosocomial candidemia.Conclusions Nosocomial candidemia is more common in the patients treated in ICU and surgery ward.The most common pathogen of nosocomial candidemia is C.albicans associated with high mortality.Old age,hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter are associated with death in nosocomial candidemia.