Facing Giovanny Gallegos (1-1), Akiyama and Curt Casali walked with one out and Votto delivered a sharp line drive to right to send Akiyama sliding across the plate and extend his hitting streak to six games (9 for 20, .450) after sitting out three games.
''I wanted to be instinctive,'' Votto said. ''I wasn't doing much thinking. Early in the season, I may have complicated some things. I think at times you have to let go.''
The Cardinals had loaded the bases with one out in the ninth, but Raisel Iglesias (2-2) struck Tyler O'Neill and Lane Thomas to escape.
''I saw Tyler miss a pitch he fouled right back,'' St. Louis manager Mike Shildt said. ''He kind of made some tough pitches. We weren't able to put the ball in play. You've got to put that ball in play.''
''Iglesias has been in that situation more than anyone,'' Reds manager David Bell said. ''His back was against the wall. Joey is another guy who has been in that situation more than anyone. There is no one you would want up there in that situation more than Joey.''
The Reds avoided a three-game sweep to finish 3-4 on a homestand against the Cubs and Cardinals, two of the teams they're chasing in the NL Central.
''The time is for sure running out,'' Votto said. ''We're playing the teams above us. They are big games, for sure.''
One night after the Reds needed five relievers and an infielder to pitch during a 16-2 loss, an efficient Tyler Mahle turned in a season-high seven innings. Mahle yielded four hits and three runs with two walks and three strikeouts.
Yadier Molina led off the Cardinals' two-run fifth with his second homer of the season, a liner to left that clanged off a metal banister. O'Neill doubled to deep left-center field with one out and scored on Kolten Wong's two-out double to left-center.
St. Louis starter Johan Oviedo lasted two outs into the fifth inning, allowing three hits and three runs with one walk and five strikeouts. He hit two batters, both in the fifth.
Oviedo hit Akiyama with a pitch with one out in the fifth inning. Tucker Barnhart followed with his second homer of the season, a line drive to center field that barely cleared the glove of a leaping Lane Thomas.
Brad Miller picked up where he left off on Tuesday, clubbing a shot to center field leading off the second inning for St. Louis, his fifth homer of the season. He hit a pair of two-run homers on Tuesday.
Eugenio Suarez led off the bottom of the second with a double to left-center field, went to third on a wild pitch to Mike Moustakas and scored the game-tying run on Akiyama's two-out single up the middle.
After Wednesday's last out, the Reds posted on the Great American Ball Park scoreboard a tribute to the late Tom Seaver, who passed away on Monday. Seaver pitched for the Reds from 1977-82.
The Cardinals' day off on Thursday is their last of the season. They are scheduled to play 30 games over the last 23 days of the season, making up postponements mandated by COVID-19 protocols.
The Reds will bat in the bottom of each inning of the second game of Friday's doubleheader in Pittsburgh to make up for one of the two games in Cincinnati in mid-August were postponed after a Reds player tested position for COVID-19. Cincinnati still will be considered the visiting team.
Cardinals: OF Dexter Fowler was placed on the 10-day injured list on Wednesday in a precautionary move because medication he is taking for a stomach ailment may compromise his immune system. ... 1B Rangel Ravelo was activated from the 10-day injured list.
Reds: Akiyama was hit just below the right knee with one out in the fifth inning. He stayed in the game.
Cardinals: RHP Jack Flaherty (2-0) starts against the Cubs on Friday. His last outing against the Cubs on Aug. 19 was the shortest of his career, but St. Louis came away with a 9-3 win.
Reds: RHP Luis Castillo (0-5, 4.10 ERA) goes against LHP Steven Brault of the Pirates on Friday night. Cincinnati has lost six of Castillo's seven starts while averaging 2.1 runs.
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