Bloodstream
Positive blood culture signal
Sterile-site result where early communication, Gram stain, and contamination logic matter immediately.
Best first path
- Confirm bottle signal
- Perform and communicate Gram stain
- Subculture for recovery
- Choose rapid ID if validated
- Plan susceptibility and significance review
Specimens
- Positive blood culture bottle
- Subculture isolate
- Original collection details
- Repeat blood cultures only when clinically indicated
Tests that fit
- Gram stain
- Subculture
- Rapid molecular or MALDI-TOF workflow
- Susceptibility testing
- Contaminant-versus-pathogen assessment
Pitfalls
- A common skin organism can be a true device pathogen
- One bottle does not always equal contamination
- Mixed Gram stain results need careful follow-up
- Candida in blood is not normal flora
Safety and escalation
- Escalate suspected high-risk small Gram-negative coccobacilli or unusual slow growers before extra open-bench work