infections varies with time and place; for instance, Gram-positive organisms overtook Gram-negative organisms as the predominant cause of bacteremia in the United States during the 1980s and 1990s, and rates of fungemia have greatly increased in association with a growing population of people receiving immunosuppressive treatments such as chemotherapy. Gram-negative sepsis is more common in Central and South America, Eastern Europe, and Asia than in North America and Western Europe; and in Africa, Salmonella enterica is a leading cause of bacteremia. Procedure Collection Blood cultures are typically drawn through venipuncture. Collecting the sample from an intravenous line is not recommended, as this is associated with higher contamination rates, although cultures may be collected from both venipuncture and an intravenous line to diagnose catheter-associated infections. Prior to the blood draw, the top of each collection bottle is disinfected using an alcohol swab to prevent contamination. The skin around the puncture site is then cleaned and left to dry; some protocols recommend disinfection with an alcohol-based antiseptic followed by either chlorhexidine or an iodine-based preparation, while others consider using only an alcohol-containing antiseptic to be sufficient. If blood must be drawn for other tests at the same time as a blood culture, the culture bottles are drawn first to minimize the risk of contamination. Because antimicrobial therapy can cause false negative results by inhibiting the growth of microbes, it is recommended that blood cultures are drawn before antimicrobial drugs are given, although this may be impractical in people who are critically ill. A typical blood culture collection involves drawing blood into two bottles, which together form one "culture" or "set". One bottle is designed to enhance the growth of aerobic organisms, and the other is designed to grow anaerobic organisms. In children, infection with anaerobic bacteria is uncommon, so a single aerobic bottle may be collected to minimize the amount of blood required. It is recommended that at least two sets are collected from two separate venipuncture locations. This helps to distinguish infection from contamination, as contaminants are less likely to appear in more than one set than true pathogens. Additionally, the collection of larger volumes of blood increases the likelihood that microorganisms will be detected if present. Blood culture bottles contain a growth medium, which encourages microorganisms to multiply, and an anticoagulant that prevents blood from clotting. Sodium polyanethol sulfonate (SPS) is the most commonly used anticoagulant because it does not