# Developing a Personalized Approach to Follow-Up Blood Cultures in Gram-Negative Bloodstream Infections: A Narrative Review

## TL;DR

This review explores whether follow-up blood cultures are useful in treating bloodstream infections caused by Gram-negative bacteria and suggests a personalized approach based on patient factors.

## Contribution

The paper proposes a personalized approach to using follow-up blood cultures in Gram-negative bloodstream infections based on patient-specific factors.

## Key findings

- Follow-up blood cultures have low yield in uncomplicated Gram-negative bloodstream infections.
- Selected patients with specific conditions may benefit from follow-up blood cultures.
- Randomized controlled trials are needed to confirm the effectiveness of follow-up blood cultures.

## Abstract

The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this review, we aim to evaluate the strengths and limitations of the most significant studies on FUBCs in GN-BSIs, proposing a more personalized approach for using FUBCs in GN-BSIs. FUBCs seem to have a low yield of persistent positive BC in uncomplicated GN-BSIs and no effect on mortality, but some selected patients may benefit. Available studies show different results regarding the mortality and benefit of FUBCs, mainly due to differences in methodology and patient characteristics. However, selected patients with endovascular infections, central venous catheters, unfavorable responses, and no source control seem to benefit the most. Randomized controlled trials are warranted in order to confirm these indications.