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We are having a debate regarding reporting of gram-stain morphology. The ID physicians feel that morphology is very important. They want to see "gram-positive cocci in clusters or chains or pairs". The lab personnel contend that they do not want to make a mistake and would rather report "gram-positive cocci or rods, etc. The same for gram-negative organisms. What is the current opinion?
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Currently there is absolutely no standardized way to report Gram stains, so this is my personal opinion only. I think the more information we give clinicians, the better, especially when it’s in a timely manner such as is possible in a Gram stain report. On the other hand, the last thing we want to do is to mislead clinicians.
I think saying clusters, pairs, chains, etc. is helpful if that type of morphology/structure is predominant. If a physician knows that “clusters” implies Staph, then that information may be useful. Our reporting “clusters” does not guarantee that the culture will grow Staph. The Gram stain report simply states what is seen. That said, I think there should be a formal competency process to assure that the technologist knows when to report a given morphology/structure.
Here are examples of when we use this. In a blood culture (in a normally sterile site where we would expect only one organism), we would report “Gram positive cocci in clusters suggestive of Staphylococcus” or “Gram positive cocci in chains suggestive of Streptococco/Enterococci.” In a blood culture, we would NOT report “Gram positive cocci in pairs suggestive of Streptococcus pneumoniae” because oftentimes, the blood culture will grow out Enterococcus. In a respiratory site, we would report “Gram positive cocci in pairs suggestive of Streptococcus pneumoniae” because of the site.
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