Skip to main content

Population-based assessment of the incidence, risk factors, and outcomes of anaerobic bloodstream infections

Infection volume 41, pages 41–48 (2013)Cite this article

Abstract

Background

Anaerobes are a relatively uncommon but important cause of bloodstream infection. However, their epidemiology has not been well defined in non-selected populations. We sought to describe the incidence of, risk factors for, and outcomes associated with anaerobic bacteremia.

Methods

Population-based surveillance for bacteremia with anaerobic microorganisms was conducted in the Calgary area (population 1.2 million) during the period from 2000 to 2008.

Results

A total of 904 incident cases were identified, for an overall population incidence of 8.7 per 100,000 per year; 231 (26 %) were nosocomial, 300 (33 %) were healthcare-associated community-onset, and 373 (41 %) were community-acquired. Elderly males were at the greatest risk. The most common pathogens identified were: Bacteroides fragilis group (3.6 per 100,000), Clostridium (non-perfringens) spp. (1.1 per 100,000), Peptostreptococcus spp. (0.9 per 100,000), and Clostridium perfringens (0.7 per 100,000). Non-susceptibility to metronidazole was 2 %, to clindamycin 17 %, and to penicillin 42 %. Relative to the general population, risk factors for anaerobic bloodstream infection included: male sex, increasing age, a prior diagnosis of cancer, chronic liver disease, heart disease, diabetes mellitus, stroke, inflammatory bowel disease, human immunodeficiency virus (HIV) infection, chronic obstructive pulmonary disease (COPD), and/or hemodialysis-dependent chronic renal failure (HDCRF). The 30-day mortality was 20 %. Increasing age, nosocomial acquisition, presence of malignancy, and several other co-morbid illnesses were independently associated with an increased risk of death.

Conclusion

Anaerobic bloodstream infection is responsible for a significant burden of disease in general populations. The data herein establish the extent to which anaerobes contribute to morbidity and subsequent mortality. This information is key in developing preventative, empiric treatment and research priorities.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Brook I. The role of anaerobic bacteria in bacteremia. Anaerobe. 2010;16:183–9.

    PubMed  Article  CAS  Google Scholar 

  2. Goldstein EJ. Anaerobic bacteremia. Clin Infect Dis. 1996;23(Suppl 1):S97–101.

    PubMed  Article  Google Scholar 

  3. Mandell G, Bennett J, Dolin R. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone; 2009.

    Google Scholar 

  4. Lassmann B, Gustafson DR, Wood CM, Rosenblatt JE. Reemergence of anaerobic bacteremia. Clin Infect Dis. 2007;44:895–900.

    PubMed  Article  Google Scholar 

  5. Lombardi DP, Engleberg NC. Anaerobic bacteremia: incidence, patient characteristics, and clinical significance. Am J Med. 1992;92:53–60.

    PubMed  Article  CAS  Google Scholar 

  6. Bryan CS, Reynolds KL, Kirkhart B, Brown JJ. Bacteroides bacteremia. Analysis of 142 episodes from one metropolitan area. Arch Surg. 1984;119:894–8.

    PubMed  Article  CAS  Google Scholar 

  7. Muttaiyah S, Paviour S, Buckwell L, Roberts SA. Anaerobic bacteraemia in patients admitted to Auckland City Hospital: its clinical significance. N Z Med J. 2007;120:U2809.

    PubMed  Google Scholar 

  8. 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;12:527–32.

    PubMed  Article  CAS  Google Scholar 

  9. Hung MN, Chen SY, Wang JL, et al. Community-acquired anaerobic bacteremia in adults: one-year experience in a medical center. J Microbiol Immunol Infect. 2005;38:436–43.

    PubMed  Google Scholar 

  10. Zahar JR, Farhat H, Chachaty E, Meshaka P, Antoun S, Nitenberg G. Incidence and clinical significance of anaerobic bacteraemia in cancer patients: a 6-year retrospective study. Clin Microbiol Infect. 2005;11:724–9.

    PubMed  Article  Google Scholar 

  11. Leal J, Gregson DB, Ross T, Flemons WW, Church DL, Laupland KB. Development of a novel electronic surveillance system for monitoring of bloodstream infections. Infect Control Hosp Epidemiol. 2010;31:740–7.

    PubMed  Article  Google Scholar 

  12. Friedman ND, Kaye KS, Stout JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137:791–7.

    PubMed  Google Scholar 

  13. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9.

    PubMed  Article  Google Scholar 

  14. Clinical and Laboratory Standards Institute (CLSI). Methods for antimicrobial susceptibility testing of anaerobic bacteria; Approved standard, 7th edition. CLSI document M11-A7. Wayne: CLSI; 2007.

  15. Clinical and Laboratory Standards Institute (CLSI). Interpretive criteria for identification of bacteria and fungi by DNA target sequencing; Approved guideline. CLSI document MM18-A, vol. 28, no. 12. Wayne: CLSI; 2008.

  16. Calgary Health Region. Health systems analysis: demographic data. Population by Alberta regional health authorities. Available at: http://www.calgaryhealthregion.ca. Accessed 1 Aug 2010.

  17. Renaud B, Brun-Buisson C; ICU-Bacteremia Study Group. Outcomes of primary and catheter-related bacteremia. A cohort and case–control study in critically ill patients. Am J Respir Crit Care Med. 2001;163:1584–90.

    PubMed  CAS  Google Scholar 

  18. Alberta Health Services. Health system analysis: demographic data. Available at: http://www.calgaryhealthregion.ca. Accessed 1 Aug 2010.

  19. Southern Alberta Clinic. Epidemiology of HIV. Available at: http://www.albertahealthservices.ca/6250.asp. Accessed 1 Aug 2010.

  20. Manns BJ, Mortis GP, Taub KJ, McLaughlin K, Donaldson C, Ghali WA. The Southern Alberta Renal Program database: a prototype for patient management and research initiatives. Clin Invest Med. 2001;24:164–70.

    PubMed  CAS  Google Scholar 

  21. ALTRA Southern Alberta Transplant Program. Available at: http://www.albertahealthservices.ca/services.asp?pid=service&rid=1738. Accessed 1 Aug 2010.

  22. Health Canada. Statistical report on the health of Canadians. Available at: http://www.statcan.gc.ca/pub/82-570-x/4064413-eng.htm. Accessed 01 Aug 2010.

  23. Alberta Diabetes Surveillance System. Available at: http://www.albertadiabetes.ca. Accessed 1 Aug 2010.

  24. Bernstein CN, Wajda A, Svenson LW, et al. The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol. 2006;101:1559–68.

    PubMed  Article  Google Scholar 

  25. Marrett LD, De P, Airia P, Dryer D; Steering Committee of Canadian Cancer Statistics 2008. Cancer in Canada in 2008. CMAJ. 2008;179:1163–70.

    PubMed  Google Scholar 

  26. Gabriel SE, Crowson CS, O’Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum. 1999;42:415–20.

    PubMed  Article  CAS  Google Scholar 

  27. Papaparaskevas J, Katsandri A, Pantazatou A, et al. Epidemiological characteristics of infections caused by Bacteroides, Prevotella and Fusobacterium species: a prospective observational study. Anaerobe. 2011;17:113–7.

    PubMed  Article  Google Scholar 

  28. Salonen JH, Eerola E, Meurman O. Clinical significance and outcome of anaerobic bacteremia. Clin Infect Dis. 1998;26:1413–7.

    PubMed  Article  CAS  Google Scholar 

  29. Laupland KB. Population-based epidemiology of intensive care: critical importance of ascertainment of residency status. Crit Care. 2004;8:R431–6.

    PubMed  Article  Google Scholar 

  30. Paltiel O, Ronen I, Polliack A, Epstein L. Two-way referral bias: evidence from a clinical audit of lymphoma in a teaching hospital. J Clin Epidemiol. 1998;51:93–8.

    PubMed  Article  CAS  Google Scholar 

  31. Smith LD. Virulence factors of Clostridium perfringens. Rev Infect Dis. 1979;1:254–62.

    PubMed  Article  CAS  Google Scholar 

  32. McClane B. Clostridium perfringens type C isolates rapidly upregulate their toxin production upon contact with host cells: new insights into virulence? Virulence. 2010;1:97–100.

    PubMed  Article  Google Scholar 

  33. 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;27:671–8.

    PubMed  Article  CAS  Google Scholar 

  34. Nguyen MH, Yu VL, Morris AJ, et al. Antimicrobial resistance and clinical outcome of Bacteroides bacteremia: findings of a multicenter prospective observational trial. Clin Infect Dis. 2000;30:870–6.

    PubMed  Article  CAS  Google Scholar 

  35. Aldridge KE, Ashcraft D, O’Brien M, Sanders CV. Bacteremia due to Bacteroides fragilis group: distribution of species, beta-lactamase production, and antimicrobial susceptibility patterns. Antimicrob Agents Chemother. 2003;47:148–53.

    PubMed  Article  CAS  Google Scholar 

  36. Snydman DR, Jacobus NV, McDermott LA, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005–2007). Clin Infect Dis. 2010;50(Suppl 1):S26–33.

    PubMed  Article  Google Scholar 

  37. Hecht DW. Anaerobes: antibiotic resistance, clinical significance, and the role of susceptibility testing. Anaerobe. 2006;12:115–21.

    PubMed  Article  CAS  Google Scholar 

  38. Davies HD, McGeer A, Schwartz B, et al. Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group. N Engl J Med. 1996;335:547–54.

    PubMed  Article  CAS  Google Scholar 

  39. Farley MM, Harvey RC, Stull T, et al. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993;328:1807–11.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of interest

No external financial support was obtained for this study. None of the authors had any financial, professional, or personal competing interests that would influence the conduct or reporting of this study.

Author information

Affiliations

  1. Department of Medicine, Alberta Health Services, The University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    J. T. Ngo, M. D. Parkins, D. L. Church & K. B. Laupland

  2. Department of Microbiology and Infectious Diseases, The University of Calgary, Calgary, AB, Canada

    M. D. Parkins, D. B. Gregson, J. D. D. Pitout, T. Ross & D. L. Church

  3. Department of Community Health Sciences, The University of Calgary, Calgary, AB, Canada

    K. B. Laupland

  4. Department of Critical Care Medicine, The University of Calgary, Calgary, AB, Canada

    K. B. Laupland

  5. Calgary Laboratory Services, Calgary, AB, Canada

    D. B. Gregson, J. D. D. Pitout, T. Ross & D. L. Church

Authors
  1. J. T. Ngo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. D. Parkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. B. Gregson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. D. D. Pitout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. L. Church
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. B. Laupland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. D. Parkins.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ngo, J.T., Parkins, M.D., Gregson, D.B. et al. Population-based assessment of the incidence, risk factors, and outcomes of anaerobic bloodstream infections. Infection 41, 41–48 (2013). https://doi.org/10.1007/s15010-012-0389-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-012-0389-4

Keywords

  • Bacteremia
  • Anaerobe
  • Epidemiology
  • Mortality
  • Population
  • Bacteroides