Current landscape and challenges in anaerobic bloodstream infections: epidemiology, microbiology, and clinical management

Anaerobic bloodstream infections (AnBSI) are insidious and potentially life-threatening conditions. Despite advances in diagnostics and therapy, the clinical management of AnBSI continues to face significant challenges. This review synthesizes current evidence on the epidemiology, evolving microbiology, antimicrobial resistance trends, clinical presentations, and management strategies for AnBSI. Persistent obstacles include pronounced global disparities in epidemiological data, a critical lack of rapid antimicrobial susceptibility testing methods, a scarcity of high-quality evidence to inform treatment, and ongoing under-recognition in clinical practice. To bridge these gaps, future initiatives must prioritize the development of stratified, practical guidelines that promote molecular diagnostics in high-resource settings while ensuring the routine implementation and standardization of anaerobic cultures in resource-limited settings. Concurrently, the immediate implementation of a bundled anaerobic blood culture collection strategy for high-risk populations stands as the most cost-effective intervention currently available.