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Updated: May 17, 2026
Preparation of a Blood Culture Pellet for Rapid Bacterial Identification and Antibiotic Susceptibility Testing
Published on: October 15, 2014
Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative
Jeremy Rosenblum1, Juan Lin, Mimi Kim
1Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx, NY 10467, USA. jrosenbl@montefiore.org
Background:
Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists.
Procedure:
To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009.
Results:
We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4%). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9%), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48 hours prior to onset of fever.
Conclusions:
In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10% of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48 hours prior to the onset of fever.
Insights
Repeat blood cultures in febrile neutropenia detect bacteremia in over 10% of pediatric oncology patients, especially those with prior bacteremia or prolonged hospitalization. This highlights the continued utility of serial cultures despite initial negative results.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Febrile neutropenia is a frequent cause of hospitalization for pediatric oncology patients.
- Current practice often involves repeat blood cultures despite limited evidence of their utility.
- Antibiotic initiation and declining bacteremia rates may reduce yield of repeat cultures.
Purpose of the Study:
- To determine the rate of bacterial growth in follow-up blood cultures after an initial negative result in febrile neutropenic pediatric oncology patients.
- To identify patient risk factors associated with positive follow-up blood cultures.
Main Methods:
- Retrospective review of pediatric oncology patients admitted for febrile neutropenia between 2004 and 2009.
- Analysis of blood culture results, focusing on episodes with initial negative cultures and subsequent repeat cultures.
- Identification of patient characteristics, including prior bacteremia and duration of hospitalization.
Main Results:
- Out of 457 febrile neutropenia episodes, 18.4% had an initial positive blood culture.
- In 220 episodes with an initial negative culture, repeat cultures detected bacterial growth in 10.9% of cases.
- Risk factors for positive repeat cultures included a history of bacteremia and hospitalization >48 hours before fever onset.
Conclusions:
- Bacteremia is detected significantly more often in initial blood cultures compared to repeat cultures in febrile neutropenia.
- Despite initial negative results, repeat blood cultures remain valuable, detecting bacteremia in over 10% of pediatric oncology patients.
- Patients with a history of bacteremia or prolonged pre-fever hospitalization have a doubled risk of positive repeat blood cultures.
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