Clinical relevance of follow-up blood cultures in patients with Streptococcus and Enterococcus species bacteremia.

INTRODUCTION

Follow-up blood cultures (FUBC) are often drawn in patients with bacteremia, although clinical relevance for specific pathogens such as Streptococci and Enterococci has not been demonstrated.

METHODS

Observational cohort study (2016-2021) to assess the frequency of obtaining FUBC, proportion of positive FUBC and clinical relevance of these FUBC by evaluation medical records in all patients with bacteremia caused by Streptococcus species, including Enterococcus species.

RESULTS

In total, we identified 458 patients with a positive index blood culture for Streptococcus spp. and Enterococcus spp. For patients with Streptococcal bacteremia, FUBC were drawn in 57/205 patients (27.8%), with 7/57 positives (12.3%). For patients with Enterococcal bacteremia, FUBC were drawn in 37/111 (33.3%) with 8/37 positives (21.6%). Positive FUBC did not seem to be associated with adverse outcomes such as ICU admission, mortality or longer hospitalization duration, and did not lead to any changes in type of antibiotics prescribed. Antibiotic treatment duration was prolonged in 1/15 patients with positive FUBC.

CONCLUSION

The occurrence of positive FUBC in patients with Streptococcal spp. or Enterococcal spp. bacteremia is infrequent, and the results of FUBC rarely lead to alternative diagnoses or treatment decisions. Moreover, positive FUBC are not associated with adverse clinical outcomes. Therefore, we conclude that the added yield of positive FUBC in patients with Streptococcal spp. or Enterococcal spp. bacteremia is limited. We would like to propose not obtaining FUBC in patients with Streptococcal spp. or Enterococcal spp. bacteremia as standard practice, in light of diagnostic stewardship.