Blood Cultures Time-to-Positivity as an Antibiotic Stewardship Tool in Immunocompromised Children with Gram-Negative Bacteraemia

Abstract

Background/Objectives: Children and adolescents with haematologic malignancies or other causes of immunosuppression are at high risk of severe infections. Determining the probability of Gram-negative bacilli bloodstream infections (GNB-BSI) within 24 h of blood culture (BC) incubation could support early antibiotic de-escalation, compared to the current guidelines recommending de-escalation after 48–72 h. Methods: Retrospective, observational single-centre study describing BC time-to-positivity (TTP) in GNB-BSI in a paediatric cohort of immunocompromised children. Results: In 128 episodes (100 patients), TTP was less than 24 h in >95% cases. TTP did not differ based on sex, underlying disease, degree of neutropenia, or PICU admission. Antibiotic initiation prior to BC collection and microbiological aetiology (microbiological aetiology different from Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae) were the only identified risk factors associated with BC growth beyond 24 h. No patients with late BC growth died or required PICU admission. Conclusions: If BC remains negative after 24 h of incubation, GNB-BSI is unlikely in immunocompromised children and adolescents with fever. These results support early de-escalation strategies, shortening unnecessary exposure to broader-spectrum antibiotics, and potentially decreasing adverse events and costs.

Keywords

• antimicrobial stewardship
• bloodstream infection
• febrile neutropenia
• Gram-negative
• immunocompromised
• oncology