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This review describes the microbiology, diagnosis and management of bacteremia caused by …

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Diagnosis and clinical features
- Clinical review: Bacteremia caused by anaerobic bacteria in children

The clinical features of anaerobic bacteremia are not much different from those associated with other types of bacteremia in children; however, a relatively longer period is generally needed before an etiologic diagnosis can be made. This can be a result of the smaller volume of blood drawn from children for culture inoculation and the longer time needed for growth and identification of anaerobic organisms.

Diagnosis should include detection of the primary infection. The clinical presentation of anaerobic bacteremia relates, in part, to the nature of the primary infection, which will typically include fever, chills and leukocytosis. Anemia, shock and intravascular coagulation may also be present. Bacteroides bacteremia is generally characterized by thrombophlebitis, metastatic infection, hyperbilirubinemia and a high mortality rate (up to 50%). Clostridium perfringens bacteremia may have a most dramatic clinical picture, consisting of hemolytic anemia, hemoglobinemia, hemoglobinuria, disseminated intravascular coagulation, bleeding tendency, bronze-colored skin, hyperbilirubinemia, shock, oliguria and anemia. Clostridial bacteria may, however, be transient and inconsequential. However, C. septicum infection may be a marker for a silent colonic or rectal malignancy [40].

Blood culture supporting the growth of anaerobic bacteria should be used routinely in all patients. In addition to supporting the growth of strict anaerobes, blood cultures also facilitate the growth of many facultative anaerobes. Some cases of culture-negative endocarditis, fever and systemic toxicity with negative blood cultures are undoubtedly cases of anaerobic bacteremia that elude detection because of inadequate methodology.

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