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Background: 18F-fluorodeoxyglucose positron emission tomography–CT (FDG-PET/CT) is useful for identifying infective endocarditis (IE) but also the detection of other concomitant septic foci. Previously, we found that FDG-PET/CT identified an osteoarthritic septic graft (OASG) in 19.1% of IE patients, frequently asymptomatic. These preliminary results encouraged us to extend our analyses to a larger population, including all patients initially explored for suspected IE, to assess the prevalence, characteristics, and OASG locations brought out by FDG-PET/CT and to identify predictive factors. Methods: From a single-center cohort of patients referred for a clinical and/or biological suspicion of IE, we included all patients who underwent FDG-PET/CT, mainly performed to confirm a prosthesis heart valve or a foreign cardiac device infection. We excluded those who did not meet the 2015 modified Duke Criteria and those for whom another infectious diagnosis was finally retained or for whom all bacterial samples were negative. Demographic, clinical, bacteriological, imaging, and therapeutic data were collected. FDG-PET/CT images were retrospectively analyzed by three blinded nuclear medicine specialists to identify OASGs. Results: We identified 72 distinct OASG locations by FDG-PET/CT in 48 of 174 patients (27.6%), mainly located in the spine (21 OASGs in 20 patients); 14 patients (8.0%) had several OASG locations. In total, 43.8% of OASG locations were asymptomatic. In multivariate analysis, the presence of OASGs was associated with musculoskeletal pain (p < 0.001) and tricuspid valve involvement (p = 0.002). Conclusions: FDG-PET/CT is useful for identifying OASGs in patients with suspected IE, especially those with tricuspid IE or musculoskeletal pain. The identification of OASGs could impact antibiotic therapy and would allow adapted orthopedic management to be proposed. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) typically occurs in patients with underlying cardiac conditions (UCC). Little is known about IE in patients without UCC. We aimed to describe the clinical, microbiological and imaging characteristics, management, and in-hospital mortality of IE patients without UCC. We analysed the data of patients with definite IE included in an observatory between 1st January 2009 and 31st December 2019. We described patients without UCC compared to those with UCC. Of 1502 IE patients, 475 (31.6%) had no UCC. They were younger (median 64.0 [19.0–101.0] vs. 70.0 [18.0–104.0] years, p <.001), more often on chronic haemodialysis (5.5% vs. 2.7%, p =.008), and had more often malignancy (22.5% vs. 17.3%, p =.017), immune deficiency (10.3% vs. 6.4%, p =.008), and an indwelling central venous line (14.5% vs. 7.0%, p <.001). They more often developed cerebral complications (34.7% vs. 27.5%, p =.004) and extracerebral embolism (48.6% vs. 36.1%, p <.001). Causative microorganisms were less often coagulase negative staphylococci (5.9% vs. 10.8%, p =.002) or enterococci (10.3% vs. 15.0%, p =.014) and more often group D streptococci (14.1% vs. 10.0%, p =.020). Vegetations were more common (92.8% vs. 77.0%, p <.001) and larger (14.0 [1.0–87.0], vs. 12.0 [0.5–60.0] mm, p =.002). They had more valve perforation or valve regurgitation (67.4% vs. 53.0%, p <.001) and underwent valve surgery more often (53.5% vs. 36.3%, p <.001). In-hospital mortality did not significantly differ between groups. Patients with IE and no UCC were younger than those with UCC, had specific comorbidities and portals of entry, and a more severe disease course. [ABSTRACT FROM AUTHOR]