Febrile neutropenia (FN) is a complication of hematologic malignancy therapy. An early diagnosis would allow optimization of antimicrobials. The ¹⁸F-FDG-PET-CT may be useful; however, its role is not well established. We analyzed retrospectively patients with hematological malignancies who underwent ¹⁸F-FDG-PET-CT as part of FN management in our university hospital and compared with conventional imaging. In addition, we performed a systematic review of the literature assessing the usefulness of ¹⁸F-FDG-PET-CT in FN. A total of 24 cases of FN underwent ¹⁸F-FDG-PET-CT. In addition, 92% had conventional CT. In 5/24 episodes (21%), the fever was of infectious etiology: two were bacterial, two were fungal, and one was parasitic. When compared with conventional imaging, ¹⁸F-FDG-PET-CT had an added value in 20 cases (83%): it diagnosed a new site of infection in 4 patients (17%), excluded infection in 16 (67%), and helped modify antimicrobials in 16 (67%). Antimicrobials could be discontinued in 10 (41.6%). We identified seven publications of low quality and one randomized trial. Our results support those of the literature. The available data suggest that ¹⁸F-FDG-PET-CT is useful in the management of FN, especially to diagnose fungal infections and rationalize antimicrobials. This review points out the low level of evidence and indicates the gaps in knowledge.

Background: Invasive fungal infections are a major threat in solid organ transplant (SOT) recipients. Trichosporon spp. are emerging yeasts associated with high mortality and therapeutic difficulties. Methods: Retrospective study of SOT recipients with invasive Trichosporon spp. infection at a tertiary hospital in Spain (2017–2025) was performed. Demographic, clinical, microbiological, and outcome data were analyzed. Results: Sixteen patients (56.2% male; median age 54 years) (lung: eight; heart: five; liver: three) with infection due to Trichosporon austroamericanum were included. Hospital mortality was 50% (8 out of 16 patients). The infection originated at the surgical site in 14 cases (87.5%), with progression to fungemia in 6 patients, all of whom died. Univariate analysis identified breakthrough infection (p = 0.010), concomitant antibiotics (p = 0.026), high-dose corticosteroid therapy (p = 0.020), and ICU admission at diagnosis (p = 0.001) as risk factors for mortality. All strains exhibited favorable in vitro susceptibility to voriconazole, isavuconazole, posaconazole and amphotericin B and high MICs for echinocandins. Conclusions: Invasive Trichosporon spp. infection in SOT recipients is linked to considerable mortality, especially in surgical site infections complicated by fungemia. Mortality is associated with severe immunosuppression, breakthrough infection, concomitant antibiotics, ICU admission, and delayed diagnosis. The combined administration of broad-spectrum antibiotics and echinocandins was associated with mortality.