Advertisement

Epidemiology and outcome of anaerobic bacteremia in a tertiary hospital

Published:August 31, 2022DOI:https://doi.org/10.1016/j.ejim.2022.08.024

      Highlights

      • This article aims to describe the epidemiology of anaerobic bacteremia and to identify risk factors affecting mortality and the impact of treatment.
      • Anaerobic bacteremia is responsible for a high mortality rate at day 30.
      • Bacteroides fragilis group, Fusobacterium spp., Clostridium spp. and Gram-positive anaerobic cocci are the anaerobes most involved in anaerobic bacteremia.
      • Time to positivity ≥ of 30 h is associated with a lower risk of 30-day mortality.
      • The administration of an adequate empirical antibiotic therapy improved the patient's survival.

      Abstract

      Despite a low incidence, anaerobic bacteremia remains a serious and often underestimated condition. This retrospective study aims to describe the epidemiology of anaerobic bacteremia and to identify risk factors affecting mortality and the impact of treatment. We included all positive anaerobic blood cultures from January 2018 to December 2019 at the University Hospital of Charleroi (Belgium). We identified 105 episodes of clinically significant anaerobic bacteremia (mean age of patients: 66.4 +/- 16.8 years). The main comorbidities were hypertension, chronic kidney disease, and diabetes. Bacteremia was community-acquired in 70.5% of the episodes. Two thirds of the blood cultures were mono-microbial, and the commonest bacteria found were Bacteroides fragilis group (31.4%), Fusobacterium spp. (17.1%) and Clostridium spp. (15.2%). The main sources of bacteremia were abdominal (35.2%), urinary (17.1%), osteoarticular (14.2%) and pulmonary (12.3%). Surgery within 30 days before hospitalization was more frequent in patients with nosocomial bacteremia (45.2% vs 2.7%, p < 0.0001). An appropriate empirical antibiotic therapy was initiated in 74.7% of patients, and the median duration of antibiotic therapy was 10 [5 - 15] days. One third of patients had a surgical management. Patients who did not survive at day 30 (n = 23 [21.9%]) had significantly lower time to positivity (TTP) values than patients alive at day 30, presented more often with sepsis, had higher Charlson scores and chronic kidney disease, and were more likely to suffer from Clostridium spp. bacteremia. In a Cox proportional hazard analysis, sepsis (OR: 7.32 [95% CI: 2.83– 18.97], p< 0.0001) was identified as an independent risk factors for 30-day mortality, whereas time to positivity ≥ 30 h (OR: 0.24 [95% CI: 0.07 – 0.84], p = 0.025) and an adequate empirical antibiotic therapy (OR: 0.37 [95% CI: 0.15 – 0.94], p = 0.037) were associated with better outcomes. Anaerobic bacteremia has a high mortality rate which justifies the maintenance of empirical antibiotic therapy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brook I
        The role of anaerobic bacteria in bacteremia.
        Anaerobe. 2010; 16: 183-189
        • Shenoy PA
        • Vishwanath S
        • Gawda A
        • Shetty S
        • Anegundi R
        • Varma M
        • et al.
        Anaerobic bacteria in clinical specimens - frequent, but a neglected lot: a five-year experience at a tertiary care hospital.
        J Clin Diagn Res. 2017; 11: DC44-DC48
        • Blairon L
        • De Gheldre Y
        • Delaere B
        • Sonet A
        • Bosly A
        • Glupczynski Y
        A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital.
        Clin Microbiol Infect. 2006; 12: 527-532
        • Goldstein EJ
        Anaerobic bacteremia.
        Clin Infect Dis. 1996; 23: S97-101
        • Salonen JH
        • Eerola E
        • Meurman O
        Clinical significance and outcome of anaerobic bacteremia.
        Clin Infect Dis. 1998; 26: 1413-1417
        • Gajdács M
        • Urbán E
        Relevance of anaerobic bacteremia in adult patients: a never-ending story?.
        Eur J Microbiol Immunol. 2020; 10: 64-75
        • Brook I
        Spectrum and treatment of anaerobic infections.
        J Infect Chemother. 2016; 22: 1-13
        • Dumont Y
        • Froissart R
        • Bañuls A-L
        • Bonzon L
        • Jean-Pierre H
        • Godreuil S
        Bactéries anaérobies et résistances aux antibiotiques.
        Rev Francoph Lab. 2018; 2018: 57-62
        • Kim J
        • Lee Y
        • Park Y
        • Kim M
        • Choi JY
        • Yong D
        • et al.
        Anaerobic bacteremia: impact of inappropriate therapy on mortality.
        Infect Chemother. 2016; 48: 91-98
        • Rodríguez-Sánchez B
        • Alcalá L
        • Marín M
        • Ruiz A
        • Alonso E
        • Bouza E
        Evaluation of MALDI-TOF MS (matrix-assisted laser desorption-ionization time-of-flight mass spectrometry) for routine identification of anaerobic bacteria.
        Anaerobe. 2016; 42: 101-107
        • Diekema DJ
        • Beekmann SE
        • Chapin KC
        • Morel KA
        • Munson E
        • Doern GV
        Epidemiology and outcome of nosocomial and community-onset bloodstream infection.
        J Clin Microbiol. 2003; 41: 3655-3660
        • Quan H
        • Li B
        • Couris CM
        • Fushimi K
        • Graham P
        • Hider P
        • et al.
        Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.
        Am J Epidemiol. 2011; 173: 676-682
        • Singer M
        • Deutschman CS
        • Seymour CW
        • Shankar-Hari M
        • Annane D
        • Bauer M
        • et al.
        The third international consensus definitions for sepsis and septic shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Khwaja A
        KDIGO clinical practice guidelines for acute kidney injury.
        Nephron Clin Pract. 2012; 120: c179-c184
        • Levey AS
        • Eckardt KU
        • Tsukamoto Y
        • Levin A
        • Coresh J
        • Rossert J
        • De Zeeuw D
        • et al.
        Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO).
        Kidney Int. 2005; 67: 2089-2100
        • Lamy B
        Reprint of: blood culture time-to-positivity: making use of the hidden information.
        Clin Microbiol Infect. 2019; 25: 399-402
        • Vena A
        • Muñoz P
        • Alcalá L
        • Fernandez-Cruz A
        • Sanchez C
        • Valerio M
        • et al.
        Are incidence and epidemiology of anaerobic bacteremia really changing?.
        Eur J Clin Microbiol Infect Dis. 2015; 34: 1621-1629
        • Wilson JR
        • Limaye AP
        Risk factors for mortality in patients with anaerobic bacteremia.
        Eur J Clin Microbiol Infect Dis. 2004; 23: 310-316
        • Lazarovitch T
        • Freimann S
        • Shapira G
        • Blank H
        Decrease in anaerobe-related bacteraemias and increase in Bacteroides species isolation rate from 1998 to 2007: a retrospective study.
        Anaerobe. 2010; 16: 201-205
        • Lassmann B
        • Gustafson DR
        • Wood CM
        • Rosenblatt JE
        Reemergence of anaerobic bacteremia.
        Clin Infect Dis. 2007; 44: 895-900
        • Robert R
        • Deraignac A
        • Le Moal G
        • Ragot S
        • Grollier G
        Prognostic factors and impact of antibiotherapy in 117 cases of anaerobic bacteraemia.
        Eur J Clin Microbiol Infect Dis. 2008; 27: 671-678
        • Fenner L
        • Widmer AF
        • Straub C
        • Frei R
        Is the incidence of anaerobic bacteremia decreasing? Analysis of 114,000 blood cultures over a ten-year period.
        J Clin Microbiol. 2008; 46: 2432-2434
        • Stabler S
        • Titécat M
        • Duployez C
        • Wallet F
        • Loïez C
        • Bortolotti P
        • et al.
        Clinical relevance of Clostridium bacteremia: an 8-year retrospective study.
        Anaerobe. 2020; 63102202
        • Umemura T
        • Hamada Y
        • Yamagishi Y
        • Suematsu H
        • Mikamo H
        Clinical characteristics associated with mortality of patients with anaerobic bacteremia.
        Anaerobe. 2016; 39: 45-50
        • Badri M
        • Nilson B
        • Ragnarsson S
        • Senneby E
        • Rasmussen M
        Clinical and microbiological features of bacteraemia with Gram-positive anaerobic cocci: a population-based retrospective study.
        Clin Microbiol Infect. 2019; 25: 760.e1-760.e6
        • Martín-Gutiérrez G
        • Martín-Pérez C
        • Gutiérrez-Pizarraya A
        • Lepe JA
        • Cisneros JM
        • Aznar J
        Time to positivity of blood cultures in patients with bloodstream infections: a useful prognostic tool.
        Enferm Infecc Microbiol Clin. 2017; 35: 638-644