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While patients presenting with neutropenic fever have high rates of initial bacteraemia (Freifeld et al, 2011), follow-up blood cultures appear to have a very low yield (Serody et al, 2000; Wattier et al, 2015; Neemann et al, 2016). As previous studies have examined only small numbers of patients, we used a data linkage approach to assess the frequency and predictors of new isolates in follow-up blood cultures during episodes of suspected neutropenic sepsis. Blood cultures drawn during episodes of suspected neutropenic sepsis in haematology patients at St Vincent’s Hospital Melbourne between January 2008 and June 2016 were identified by linking data from multiple institutional databases as outlined in the online Data S1. The protocol was approved as a quality-assurance activity by our Quality and Risk unit.

The clinical haematology unit at our institution admits 450 patients and performs 20–25 autologous haematopoetic stem cell transplants per year. Approximately a quarter of patients screened on the haematology ward are found to be colonised with vancomycin-resistant Enterococcus faecium (VRE), and the ward was affected by an institutional outbreak of KPC2-producing Klebsiella pneumoniae during the study period (Cronin et al, 2017). Throughout the study period, institutional guidelines recommended piperacillin-tazobactam monotherapy as the first-line empiric regimen with vancomycin added for severe sepsis and suspected central line infection. Primary fluoroquinolone prophylaxis was not used during the study period.