ArticleJournal of clinical microbiology2016
Multicenter Assessment of Gram Stain Error Rates.
Article in Journal of clinical microbiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 42 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 100 citations in OpenAlex.
- Comparison of Gram stain interpretation accuracy between a computer-aided diagnosis app and microbiology specialists in blood culture samples.Microbiology spectrum · 2026Observational
- Gram staining decipherment using an artificial intelligence-powered smartphone-based application.Microbiology spectrum · 2026Observational
- Evolving microbiology laboratories: mastering automated culture-based processes and molecular assays, an institutional experience.Frontiers in cellular and infection microbiology · 2026Review
- When 'Clean' is not clean: a diagnostic pitfall in Gram staining leading to pseudobacterial meningitis.Access microbiology · 2026Article
- Assessing the Validity and Impact of Remote Digital Image Reading in Fungal Diagnostics.Mycopathologia · 2025Article
- Accuracy of classification of urinary Gram-stain findings by a computer-aided diagnosis app compared with microbiology specialists.Journal of medical microbiology · 2025Article
- A novel framework for the automated characterization of Gram-stained blood culture slides using a large-scale vision transformer.Journal of clinical microbiology · 2025Article
- Virtual Gram staining of label-free bacteria using dark-field microscopy and deep learning.Science advances · 2025Article
- Assessment of a rapid diagnostic test based on loop-mediated isothermal amplification (LAMP) to identify the most frequent pathogens causing hospital-acquired pneumonia.Frontiers in cellular and infection microbiology · 2025Article
- Improvement of gram staining effect by ethanol pretreatment and quantization of staining image by unsupervised machine learning.Archives of microbiology · 2024Article
- Performance evaluation of machine-assisted interpretation of Gram stains from positive blood cultures.Journal of clinical microbiology · 2024Article
- Determining causal pathogens and inflammatory state of mastitis in dairy cows via Gram staining of precipitates in milk.Frontiers in veterinary science · 2024Article
- Competency Assessment on Gram Stain Examination and Interpretation Among Medical Laboratory Professionals Working in Selected Hospitals of Addis Ababa, Ethiopia.Journal of multidisciplinary healthcare · 2024Article
- Wash-Free Bacterial Gram-Typing and Photodynamic Inactivation with Long-Chain-Tailed BODIPY Derivatives.Biomaterials research · 2024Article
- Article
- Multispectral in-line hologram reconstruction with aberration compensation applied to Gram-stained bacteria microscopy.Scientific reports · 2023Article
- Simple and Rapid Discrimination of Methicillin-Resistant Staphylococcus aureus Based on Gram Staining and Machine Vision.Microbiology spectrum · 2023Article
- Direct-from-Blood Detection of Pathogens: a Review of Technology and Challenges.Journal of clinical microbiology · 2023Review
- Test Performance and Potential Clinical Utility of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel.Microbiology spectrum · 2023Article
- Diagnostic performance of an in-house multiplex PCR assay and the retrospective surveillance of bacterial respiratory pathogens at a teaching hospital, Kelantan, Malaysia.Pathogens and global health · 2023Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
4 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Gram stains remain the cornerstone of diagnostic testing in the microbiology laboratory for the guidance of empirical treatment prior to availability of culture results. Incorrectly interpreted Gram stains may adversely impact patient care, and yet there are no comprehensive studies that have evaluated the reliability of the technique and there are no established standards for performance. In this study, clinical microbiology laboratories at four major tertiary medical care centers evaluated Gram stain error rates across all nonblood specimen types by using standardized criteria. The study focused on several factors that primarily contribute to errors in the process, including poor specimen quality, smear preparation, and interpretation of the smears. The number of specimens during the evaluation period ranged from 976 to 1,864 specimens per site, and there were a total of 6,115 specimens. Gram stain results were discrepant from culture for 5% of all specimens. Fifty-eight percent of discrepant results were specimens with no organisms reported on Gram stain but significant growth on culture, while 42% of discrepant results had reported organisms on Gram stain that were not recovered in culture. Upon review of available slides, 24% (63/263) of discrepant results were due to reader error, which varied significantly based on site (9% to 45%). The Gram stain error rate also varied between sites, ranging from 0.4% to 2.7%. The data demonstrate a significant variability between laboratories in Gram stain performance and affirm the need for ongoing quality assessment by laboratories. Standardized monitoring of Gram stains is an essential quality control tool for laboratories and is necessary for the establishment of a quality benchmark across laboratories.
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