Are Follow-Up Blood Cultures Useful in the Antimicrobial Management of Gram Negative Bacteremia? A Reappraisal of Their Role Based on Current Knowledge

Abstract

Bloodstream infections still constitute an outstanding cause of in-hospital morbidity and mortality, especially among critically ill patients. Follow up blood cultures (FUBCs) are widely recommended for proper management of Staphylococcus aureus and Candida spp. infections. On the other hand, their role is still a matter of controversy as far as Gram negative bacteremias are concerned. We revised, analyzed, and commented on the literature addressing this issue, to define the clinical settings in which the application of FUBCs could better reveal its value. The results of this review show that critically ill patients, endovascular and/or non-eradicable source of infection, isolation of a multi-drug resistant pathogen, end-stage renal disease, and immunodeficiencies are some factors that may predispose patients to persistent Gram negative bacteremia. An analysis of the different burdens that each of these factors have in this clinical setting allowed us to suggest which patients’ FUBCs have the potential to modify treatment choices, prompt an early source control, and finally, improve clinical outcome.

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

“…More recently, Cogliati Dezza and colleagues elegantly summarized and reappraised the evidence in the literature for obtaining FUBC in patients with GN-BSI [23]. Graded recommendations to obtain FUBC were proposed based on clinical and microbiological risk factors derived from prior studies [23]. Despite the small number of patients with persistent GN-BSI in the current cohort, the results seem to be in agreement for the most part with the proposed guidelines in the review [23].…”

“…More recently, Cogliati Dezza and colleagues elegantly summarized and reappraised the evidence in the literature for obtaining FUBC in patients with GN-BSI [23]. Graded recommendations to obtain FUBC were proposed based on clinical and microbiological risk factors derived from prior studies [23].…”

“…Graded recommendations to obtain FUBC were proposed based on clinical and microbiological risk factors derived from prior studies [23]. Despite the small number of patients with persistent GN-BSI in the current cohort, the results seem to be in agreement for the most part with the proposed guidelines in the review [23]. The proportion of patients with persistently positive FUBC ranged from 13% to 19% in the presence of either clinical or microbiological risk factors and exceeded 30% in the presence of both (Table 4).…”

Outcomes with Cefiderocol Treatment in Patients with Bacteraemia Enrolled into Prospective Phase 2 and Phase 3 Randomised Clinical Studies

“…The analysis highlights the need for better protocol compliance with on- and post-therapy blood cultures [ 31 – 33 ] in randomised clinical trials involving site-specific infections with concomitant bacteraemia to provide a more accurate assessment of bacteraemia clearance. Our post hoc analysis data are complemented by efficacy findings for cefiderocol in real-life cases of difficult-to-treat severe gram-negative infections.…”

Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside

“…The case is different from the condition of classical thrombophlebitis, which refers to the ab-externo inflammation of a thrombosed vein that always requires surgical debridement [6]; ST may be cured with prolonged targeted antimicrobial therapy and anticoagulation [1,[3][4][5]. GNB ST in particular represents a subtle and often misleading condition, with rapid clinical improvement once targeted antibiotic treatment commences, despite remarkable delay of bacteremia clearance [9,10,14,15]. As a matter of fact, if FUBCs are not performed, the treating physician may fail to recognize the ST, mistakenly considering the patient cured, and then discontinue antimicrobials too soon.…”