PT - JOURNAL ARTICLE AU - Pijl, Jordy P. AU - Glaudemans, Andor W.J.M. AU - Gheysens, Olivier AU - Slart, Riemer H.J.A. AU - Kwee, Thomas C. TI - Importance of Blood Glucose Management Before <sup>18</sup>F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin AID - 10.2967/jnumed.122.264839 DP - 2023 Aug 01 TA - Journal of Nuclear Medicine PG - 1287--1294 VI - 64 IP - 8 4099 - http://jnm.snmjournals.org/content/64/8/1287.short 4100 - http://jnm.snmjournals.org/content/64/8/1287.full SO - J Nucl Med2023 Aug 01; 64 AB - We investigated the effects of blood glucose levels on the performance of 18F-FDG PET/CT for detecting an infection focus in patients with bacteremia. Methods: A total of 322 consecutive patients with bacteremia who underwent 18F-FDG PET/CT between 2010 and 2021 were included. Logistic regression analysis was performed to evaluate the association between finding a true-positive infection focus on 18F-FDG PET/CT and blood glucose level, type of diabetes, and use of hypoglycemic medication. C-reactive protein, leukocyte count, duration of antibiotic treatment, and type of isolated bacteria were considered as well. Results: Blood glucose level (odds ratio, 0.76 per unit increase; P = &lt;0.001) was significantly and independently associated with 18F-FDG PET/CT outcome. In patients with a blood glucose level between 3.0 and 7.9 mmol/L (54–142 mg/dL), the true-positive detection rate of 18F-FDG PET/CT varied between 61% and 65%, whereas in patients with a blood glucose level between 8.0 and 10.9 mmol/L (144–196 mg/dL), the true-positive detection rate decreased to 30%–38%. In patients with a blood glucose level greater than 11.0 mmol/L (200 mg/dL), the true-positive detection rate was 17%. In addition to C-reactive protein (odds ratio, 1.004 per point increase; P = 0.009), no other variables were independently associated with 18F-FDG PET/CT outcome. Conclusion: In patients with moderate to severe hyperglycemia, 18F-FDG PET/CT was much less likely to identify the focus of infection than in normoglycemic patients. Although current guidelines recommend postponing 18F-FDG PET/CT only in cases of severe hyperglycemia with glucose levels greater than 11 mmol/L (200 mg/dL), a lower blood glucose threshold seems to be more appropriate in patients with bacteremia of unknown origin and other infectious diseases.