{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:20:45Z","timestamp":1792682445607,"version":"4.5.0"},"reference-count":20,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2017,6,30]],"date-time":"2017-06-30T00:00:00Z","timestamp":1498780800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/legalcode"}],"content-domain":{"domain":["openmicrobiologyjournal.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["TOMICROJ"],"published-print":{"date-parts":[[2017,6,30]]},"abstract":"<jats:sec><jats:title>Introduction:<\/jats:title><jats:p><jats:italic>Acinetobacter baumannii<\/jats:italic>and<jats:italic>Brucella<\/jats:italic>species are Gram-negative organisms that are vulnerable to misinterpretation as Gram-positive or Gram-variable in blood cultures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective:<\/jats:title><jats:p>We assess the random errors in gram stain interpretation to reduce the likelihood of such errors and therefore patient harm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology:<\/jats:title><jats:p>Aerobic and anaerobic blood cultures from two patients in an acute care facility in Saudi Arabia were subjected to preliminary Gram-staining. In case 1, VITEK-2 Anaerobe Identification, repeat Gram staining from a blood agar plate, Remel BactiDrop\u2122 Oxidase test, Urea Agar urease test and real-time PCR were used to confirm presence of<jats:italic>Brucella<\/jats:italic>and absence of<jats:italic>Coryneform<\/jats:italic>species. In case 2, repeat Gram- staining from the plate and the vials, VITEK-2 Gram-Negative Identification, real-time PCR and subculture on to Columbia agar, blood agar, and MacConkey agar were carried out to identify<jats:italic>A. baumannii<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>In case 1, initially pleomorphic Gram-positive bacteria were identified.<jats:italic>Coryneform<\/jats:italic>species were suspected. Tiny growth was observed after 24 h on blood agar plates, and good growth by 48 h. Presence of<jats:italic>Brucella<\/jats:italic>species was ultimately confirmed. In case 2, preliminary Gram-stain results suggested giant Gram-positive oval cocci. Further testing over 18-24 h identified<jats:italic>A. baumannii<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Oxidase test from the plate and urease test from the culture vial is recommended after apparent identification of pleomorphic Gram-positive bacilli from blood culture, once tiny growth is observed, to distinguish<jats:italic>Brucella<\/jats:italic>from<jats:italic>Corynebacterium<\/jats:italic>species. If giant Gram-positive oval cocci are indicated by preliminary Gram-staining, it is recommended that the Gram stain be repeated from the plate after 4-6 h, or culture should be tested in Triple Sugar Iron (TSI) medium and the Gram stain repeated after 2-4 h incubation.<\/jats:p><\/jats:sec>","DOI":"10.2174\/1874285801711010126","type":"journal-article","created":{"date-parts":[[2017,7,12]],"date-time":"2017-07-12T06:21:38Z","timestamp":1499840498000},"page":"126-131","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Misinterpretation of Gram Stain from the Stationary Growth Phase of Positive Blood Cultures for Brucella and Acinetobacter Species"],"prefix":"10.2174","volume":"11","author":[{"given":"Ali M.","family":"Bazzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaffar A.","family":"Al-Tawfiq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali A.","family":"Rabaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Percival SL, Williams DW. Chapter Two \u2013 Acinetobacter. In: Percival S, Yates MV, Williams D, Chalmers R, Gray N, Eds. Microbiology of Waterborne Diseases. 2nd ed. Amsterdam: Elsevier Inc. 2014; pp. 35-48.","DOI":"10.1016\/B978-0-12-415846-7.00002-0"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"243","DOI":"10.4161\/viru.19700","volume":"3","author":"Howard A.","year":"2012","unstructured":"Howard A, O\u2019Donoghue M, Feeney A, Sleator RD. Acinetobacter baumannii: an emerging opportunistic pathogen. Virulence 2012; 3 (3) : 243-50.","journal-title":"Virulence"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1128\/CMR.00058-07","volume":"21","author":"Peleg A.Y.","year":"2008","unstructured":"Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008; 21 (3) : 538-82.","journal-title":"Clin. Microbiol. Rev."},{"key":"ref4","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4103\/0256-4947.67073","volume":"30","author":"Al Johani S.M.","year":"2010","unstructured":"Al Johani SM, Akhter J, Balkhy H, El-Saed A, Younan M, Memish Z. Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia. Ann Saudi Med 2010; 30 (5) : 364-9.","journal-title":"Ann. Saudi Med."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1086\/518842","volume":"28","author":"Al-Tawfiq J.A.","year":"2007","unstructured":"Al-Tawfiq JA, Mohandhas TX. Prevalence of antimicrobial resistance in Acinetobacter calcoaceticus-baumannii complex in a Saudi Arabian hospital. Infect Control Hosp Epidemiol 2007; 28 (7) : 870-2.","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref6","author":"El-Mahdy TS","year":"2016","unstructured":"El-Mahdy TS, Al-Agamy MH, Al-Qahtani AA, Shibl AM. Detection of bla OXA-23-like and bla NDM-1 in Acinetobacter baumannii from the Eastern Region, Saudi Arabia. Microb Drug Resist 2016. [Epub ahead of print]","journal-title":"Microb. Drug Resist."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1093\/jac\/dks091","volume":"67","author":"Memish Z.A.","year":"2012","unstructured":"Memish ZA, Shibl AM, Kambal AM, Ohaly YA, Ishaq A, Livermore DM. Antimicrobial resistance among non-fermenting Gram-negative bacteria in Saudi Arabia. J Antimicrob Chemother 2012; 67 (7) : 1701-5.","journal-title":"J. Antimicrob. Chemother."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1099\/jmm.0.057216-0","volume":"62","author":"Alsultan A.A.","year":"2013","unstructured":"Alsultan AA, Evans BA, Elsayed EA, et al. High frequency of carbapenem-resistant Acinetobacter baumannii in patients with diabetes mellitus in Saudi Arabia. J Med Microbiol 2013; 62 (Pt 6) : 885-8.","journal-title":"J. Med. Microbiol."},{"key":"ref9","doi-asserted-by":"crossref","first-page":"14186","DOI":"10.5897\/AJB11.2291","volume":"10","author":"Al-Arfaj A.A.","year":"2011","unstructured":"Al-Arfaj AA, Ibrahim AS, Somily AM, Al-Salamah AA. Genetic basis of carbapenem resistance in Acinetobacter clinical isolates in Saudi Arabia. Afr J Biotechnol 2011; 10 (64) : 14186-96.","journal-title":"Afr. J. Biotechnol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1848","DOI":"10.3201\/eid1010.040076","volume":"10","author":"Noviello S.","year":"2004","unstructured":"Noviello S, Gallo R, Kelly M, et al. Laboratory-acquired brucellosis. Emerg Infect Dis 2004; 10 (10) : 1848-50.","journal-title":"Emerg. Infect. Dis."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jegh.2015.09.001","volume":"6","author":"Aloufi A.D.","year":"2016","unstructured":"Aloufi AD, Memish ZA, Assiri AM, McNabb SJ. Trends of reported human cases of brucellosis, Kingdom of Saudi Arabia, 2004-2012. J Epidemiol Glob Health 2016; 6 (1) : 11-8.","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jiph.2009.03.003","volume":"2","author":"Al-Tawfiq JA","year":"2009","unstructured":"Al-Tawfiq JA, Abukhamsin A. A 24-year study of the epidemiology of human brucellosis in a health-care system in Eastern Saudi Arabia. J of Infec and Public Health 2009; 2 (2) : 81-5.","journal-title":"J. of Infec. and Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1128\/CMR.3.3.227","volume":"3","author":"Coyle M.B.","year":"1990","unstructured":"Coyle MB, Lipsky BA. Coryneform bacteria in infectious diseases: clinical and laboratory aspects. Clin Microbiol Rev 1990; 3 (3) : 227-46.","journal-title":"Clin. Microbiol. Rev."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1111\/j.1469-0691.2008.02023.x","volume":"14","author":"Soriano F.","year":"2008","unstructured":"Soriano F, Tauch A. Microbiological and clinical features of Corynebacterium urealyticum: urinary tract stones and genomics as the Rosetta Stone. Clin Microbiol Infect 2008; 14 (7) : 632-43.","journal-title":"Clin. Microbiol. Infect."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1093\/jac\/dkm497","volume":"61","author":"Kerremans J.J.","year":"2008","unstructured":"Kerremans JJ, Verboom P, Stijnen T, et al. Rapid identification and antimicrobial susceptibility testing reduce antibiotic use and accelerate pathogen-directed antibiotic use. J Antimicrob Chemother 2008; 61 (2) : 428-35.","journal-title":"J. Antimicrob. Chemother."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1128\/JCM.41.1.495-497.2003","volume":"41","author":"Munson E.L.","year":"2003","unstructured":"Munson EL, Diekema DJ, Beekmann SE, Chapin KC, Doern GV. Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management. J Clin Microbiol 2003; 41 (1) : 495-7.","journal-title":"J. Clin. Microbiol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.jinf.2014.05.005","volume":"69","author":"Perez K.K.","year":"2014","unstructured":"Perez KK, Olsen RJ, Musick WL, et al. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia. J Infect 2014; 69 (3) : 216-25.","journal-title":"J. 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Comparison among four proposed direct blood culture microbial identification methods using MALDI-TOF MS. J Infect Public Health 2016; 16 (16) : 30068-75.","journal-title":"J. Infect. 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