Infectious diseases remain a major health problem and cause of death worldwide. It is expected that the
socio-economic impact will further intensify due to escalating resistance to antibiotics, an ageing population and
an increase in the number of patients under immunosuppressive therapy and implanted medical devices. Even
though radiolabeled probes and leukocytes are routinely used in clinical practice, it might still be difficult to distinguish
sterile inflammation from inflammation caused by bacteria. Moreover, the majority of these probes are
based on the attraction of leukocytes which may be hampered in neutropenic patients. Novel approaches that can
be implemented in clinical practice and allow for swift diagnosis of infection by targeting the microorganism
directly, are posing an attractive strategy. Here we review the current strategies to directly image bacteria using
radionuclides and we provide an overview of the preclinical efforts to develop and validate new approaches.
Indeed, significant progress has been made in the past years, but very few radiopharmaceuticals (that were promising
in preclinical studies) have made it into clinical practice. We will discuss the challenges that remain to select
good candidates for imaging agents targeting bacteria.
Keywords: Radionuclide imaging, bacterial infection, antimicrobial peptides, radiolabeled leukocytes, biomimetics, antibiotics.
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