title: Decreased mortality associated with prompt Gram staining of blood cultures.
abstract: Gram stains of positive blood cultures are the most important factor influencing appropriate therapy. The sooner appropriate therapy is initiated, the better. Therefore, it is reasonable to expect that the sooner Gram stains are performed, the better. To determine the value of timely Gram stains and whether improvement in Gram stain turnaround time (TAT) is feasible, we compared data for matched pairs of patients with cultures processed promptly (<1 hour TAT) with data for patients with cultures not processed promptly (> or =1 hour TAT) and then monitored TAT by control charting.In 99 matched pairs, average difference in time to detection of positive blood cultures within a pair of patients was less than 0.1 hour. For the less than 1 hour TAT group, the average TAT and crude mortality were 0.1 hour and 10.1%, respectively; for the 1 hour or longer TAT group, they were 3.3 hours and 19.2%, respectively (P < .0001 and P = .0389, respectively). After multifaceted efforts, we achieved significant improvement in the TAT for Gram stains.
authors.affiliation: Department of Laboratory Medicine and Pathology, Memorial Medical Center, Springfield, IL 62781, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Barenfanger
authors.forename: Donald R
authors.initials: DR
authors.lastname: Graham
authors.forename: Lavanya
authors.initials: L
authors.lastname: Kolluri
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sangwan
authors.forename: Jerry
authors.initials: J
authors.lastname: Lawhorn
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Drake
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Verhulst
authors.forename: Ryan
authors.initials: R
authors.lastname: Peterson
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Moja
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Ertmoed
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Moja
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Shevlin
authors.forename: Robert
authors.initials: R
authors.lastname: Vautrain
authors.forename: Charles D
authors.initials: CD
authors.lastname: Callahan
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000175:diagnosis* / Q000401:mortality*; D001431:Bacteriological Techniques / Q000379:methods; D005260:Female; D005840:Gentian Violet; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D009551:Night Care / Q000592:standards; D010619:Phenazines; D013194:Staining and Labeling / Q000592:standards; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet