Follow-up blood cultures in bacteremia: A potential target for diagnostic stewardship.

Objectives: Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing bacteremia and whether follow-up blood cultures in this context are associated with short- and long-term survival.

Methods: We conducted a retrospective cohort study of adult inpatients with bacteremia at the University of Maryland Medical Center in 2015-2020. Kaplan-Meier survival curves and Cox regression with time-varying covariates were used to evaluate the association between follow-up blood cultures and time to mortality within 30 days of first positive blood culture. Provider justifications for follow-up blood cultures were identified through chart review.

Results: Of 159 eligible patients, 127 (80%) had follow-up blood cultures, including 9 (7%) that were positive for and 10 (8%) that were positive for other organisms. Follow-up blood cultures were typically collected "to ensure clearance" or "to guide antibiotic therapy." Overall, 30-day mortality was 25.2%. After risk adjustment for patient characteristics, follow-up blood cultures were associated with a nonsignificant reduction in mortality risk (hazard ratio, 0.43; 95% confidence interval, 1.08; = .071). In exploratory analyses, the potential mortality reduction from follow-up blood cultures was driven by their use in patients with Pitt bacteremia scores >0.

Conclusions: Follow-up blood cultures are commonly collected for bacteremia but infrequently identify persistent bacteremia. Targeted use of follow-up blood cultures based on severity of illness may reduce unnecessary culturing.