When do repeat blood cultures make sense in hospitalized children with cancer?
The analysis was based on 573 hospitalizations (most patients had an average of 2 hospitalization episodes) in which new BCs were drawn more than 48 hours after initial cultures were negative.
When do repeat blood cultures make sense in hospitalized children with cancer? | Image Credit: Contemporary Pediatrics
Repeat blood cultures (BCs) are not necessary after 48 hours of negative cultures in hemodynamically and clinically stable hospitalized children with cancer. This was the finding of a retrospective analysis of the records of hospitalizations of such children at Riley Hospital for Children in Indianapolis, Indiana, during a 6-year period.
The analysis was based on 573 hospitalizations (most patients had an average of 2 hospitalization episodes) in which new BCs were drawn more than 48 hours after initial cultures were negative. Of these, a whopping 94.8% of the hospitalizations with initial negative BCs had repeat BCs that were again negative. Of the new positive cultures, 7 hospitalizations (1.2%) demonstrated a new pathogen or commensals treated as a pathogen, whereas another 23 (4.0%) had a contaminant BC. The most common contaminant organism, found in 14 cultures, was Staphylococcus epidermidis.
The authors also noted that all patients with new, true pathogens were hemodynamically unstable or had recurrent fever when the new positive BCs were taken. Further, the authors determined that had no additional BCs been collected beyond 48 hours of negative presentations, a total of $73,645 would have been saved in BC charges alone. Given these findings, the authors concluded that in patients who remain hemodynamically stable and demonstrate no clinical changes, it is both safe and cost-effective not to repeat BCs after 48 hours of negative cultures.
THOUGHTS FROM DR FARBER
I am a fan of “less is more.” Stable patients without recurrent fevers and whose initial BCs were negative do not need repeat late BCs. Besides the cost of the cultures themselves, there are further negative consequences, such as prolonged hospital stays (commented on by the authors), for the patient who grows out a contaminant.
Reference:
Prather CS, Wood JB, Mueller EL, Christenson JC, Alali M. The yield, safety, and cost-effectiveness of decreasing repeat blood cultures beyond 48 hours in a pediatric hematology-oncology unit. J Pediatr Hematol Oncol. 2023; 45(7):409-415. doi:10:1097/MPH.0000000000002711
