Is anaerobic blood culture necessary? If so, who needs it?

The role of anaerobic blood cultures is not validated, although they are drawn routinely.

We performed a retrospective chart review at a private hospital in Japan for patients admitted between July 1, 2004 to June 30, 2005 to determine patient characteristics resulting in anaerobic blood culture.

During the study period, 17,775 blood culture bottles were sent for the analysis, and 2132 bottles (12.0%) were positive for microbial growth. Bacteria were grown from 958 anaerobic bottles (44.7%), and 719 (33.7%) of those were judged to represent real infections, which accounted for 410 cases of bacteremia. Only 47 cases (11.5%) were detected by anaerobic cultures alone. Among those 47, obligate anaerobes represented 12 cases. Clinical evaluation could have predicted 7 of 12 cases of obligate anaerobic bacteremia. In the remaining 5 cases, the source of bacteremia was unclear. There were 2.7 cases of anaerobic bacteremia per 1000 blood cultures. The mortality attributable to anaerobic bacteremia was 50%. Among bacteremic cases not caused by obligate anaerobes yet diagnosed solely by anaerobic bottles, either the standard 2 sets of blood were not taken or their clinical outcomes were favorable.

Anaerobic blood culture can be avoided in most cases. Anaerobic blood culture may be most helpful when (1) bacteremia because of obligate anaerobes is clinically suspected, (2) patients are severely immunocompromised, and (3) source of bacteremia is not identified by clinical evaluation.