Impact of reporting gram stain results from blood culture bottles on the selection of antimicrobial agents.
We assessed the usefulness of reporting direct blood Gram stain results compared with the results of positive blood cultures in 482 episodes and monitored impact on selection of antimicrobial treatment. We found that the reporting groups "Staphylococcus spp," "Pseudomonas spp and related organisms," and "yeasts" identified in this way matched perfectly with later culture identification. When the report indicated Staphylococcus spp or Pseudomonas spp and related organisms, physicians started or changed antimicrobials suitable for these bacteria more frequently than when "other streptococci" and "family Enterobacteriaceae" were reported (P < .05). Incorrect recognition of Acinetobacter spp as Enterobacteriaceae family is still the most challenging problem in this context. Gram stain results that definitively identify Staphylococcus spp, Pseudomonas spp and related organisms, and yeasts reliably can be rapidly provided by clinical laboratories; this information has a significant impact on early selection of effective antimicrobials. Further investigation is needed to assess the clinical impact of reporting Gram stain results in bacteremia.
Department of Laboratory Medicine, Nihon University School of Medicine, Tokyo, Japan.
Yuki
Y
Uehara
Michiko
M
Yagoshi
Yumiko
Y
Tanimichi
Hiroko
H
Yamada
Kazuo
K
Shimoguchi
Sachiyo
S
Yamamoto
Mitsuru
M
Yanai
Kazunari
K
Kumasaka
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D001431:Bacteriological Techniques; D001769:Blood / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005840:Gentian Violet; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010619:Phenazines; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013194:Staining and Labeling; D015996:Survival Rate; D055815:Young Adult
D000900:Anti-Bacterial Agents; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet