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Stephen Clemence's 84th minute shot needed a big deflection to carry it beyond the despairing dive of Lee Grant but Birmingham will argue they were due a slice of luck after their first-half performance.
They should have been in control of the match but referee Uriah Rennie failed to award a penalty when David Dunn was clearly pulled down by Grant, and the out-of-form Cameron Jerome wasted a wonderful chance after the gifted Nicklas Bendtner had set him up.
Instead, Bruce had to endure a nerve-shredding second period when he anxiously patrolled his technical area as Derby hauled themselves back into the game.
The home side at last began to threaten after the interval but Birmingham secured the three points when Clemence beat Grant courtesy of a large deflection off Danish midfielder Morten Bisgaard.
Perhaps Bruce and his team will look back on that moment as a turning point in the season but Derby will argue they did not deserve to lose on the strength of their second-half display.
Seth Johnson and Adam Bolder contested the midfield and Bisgaard brought one excellent save out of Maik Taylor when the game was goalless.
Birmingham should have had something to show for their first-half performance when teenage striker Bendtner, on loan from Arsenal, pulled the home defence apart.
Grant saved brilliantly from him in the 25th minute and the Dane then opened Derby up with a back-heel but Jerome completely mis-hit his shot from 12 yards and Grant had an easy save.
Jerome was only on because Dunn had suffered a recurrence of a hamstring injury and left the field in the 24th minute. That forced Birmingham to revert to a 4-4-2 formation and the extra man in midfield allowed Derby to hit back after the break.
Bisgaard struck the outside of the post before Taylor did well to keep out an angled shot in the 71st minute and then the keeper had to dive to his right to save a Steve Howard header.
The match appeared to be heading for stalemate until Gary McSheffrey played the ball out to Clemence whose drive from the edge of the box looped off Bisgaard and went in off the inside of Grant's right-hand post.
Derby might have rescued a point in stoppage time when Bolder's low shot was deflected just wide but the final whistle brought scenes of celebration and relief on the Birmingham bench.