Repeating blood cultures during hospital stay: practice pattern at a teaching hospital and a proposal for guidelines

Guidelines for blood culture (BC) address the appropriate frequency, number and volume, but no guidelines exist for repeating BCs. The pattern of repeated BCs was studied in all patients hospitalised in December 2001 to determine the extent of and reasons for repeating cultures. BC was repeated in 127 (31.6%) of 405 adults with an initial BC during the study period. All patients with available records (n = 96; 75.6%) were included. The average patient age was 62.2 +/- 15.9 years. In total, 295 BC sets (one to four BCs/set) were obtained, comprising 96 initial and 199 repeats (one to nine repeats/patient). Sixty-nine (34.7%) repeats were taken within 24 h, and 89 (44.7%) within 2-4 days. The most common reason (32.2%) was persistent fever. The result of repeated cultures was: no growth (83.4%), same pathogen (9.1%), new pathogen (2.5%) or contamination (5.0%). Thus, BC repeats accounted for one-third of all BCs handled in the laboratory, with little additional yield. Guidelines for repeating BCs may decrease unnecessary testing.