Blood Cultures in Persistent Febrile Neutropenia: Finding the Sweet Spot

Febrile neutropenia (FN) is a frequent and potentially life-threatening complication of chemotherapy, developing in approximately 10%–50% of patients with solid tumors and >80% of those with hematologic malignancies [1]. Blood cultures are central to the diagnostic workup of FN, given that bacteremia is documented in approximately 10%–25% of cases [1]. Infectious Diseases Society of America guidelines previously recommended new sets of blood cultures for patients with persistent fever > 3 days [1]. In contrast, other guidelines such as those of the German Society of Hematology and Medical Oncology, discourage routine follow-up blood cultures once antibiotics have been initiated due to low yield, with a recommendation to obtain blood cultures in cases of clinical instability or suspected/proven resistance [2]. Repeat blood cultures for persistent FN are common in clinical practice, and identifying opportunities for diagnostic stewardship interventions in this patient population are needed. A new study in Clinical Infectious Diseases further challenges the value of repeat blood cultures in persistent FN and aims to find opportunities for a more targeted approach.