View source for Gram positive bacteria

==Interpretation of Key Phrases==
*“Gram positive cocci in clusters” may suggest [[Staphylococcus]] species. 
*"Gram positive cocci in pairs and chains" may suggest [[Streptococcus]] species or Enterococcus species
*“Branching Gram positive rods, modified acid fast stain positive” may suggest Nocardia or Streptomyces species

==Cocci==
===Clusters ([[Staph Species]])===
*Coagulase Positive: [[Staph aureus]]
**Always consider as true bacteremia (and not a [[Bacteremia Versus Contaminated Blood Cultures‎|contaminant]]) due to the danger of delaying treatment<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
*Coagulase Negative: 
**[[Staph epidermidis]]
***Most common cause of catheter-related bacteremia<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
***Most common skin [[Bacteremia Versus Contaminated Blood Cultures‎|contaminant]] found in blood cultures<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
**[[Staph saprophyticus]]
***[[UTI]]s in women
**[[Staph lugdunensis]]
***Rare cause of [[endocarditis]], [[meningitis]], and [[Skin and Soft Tissue Infections]] 
***Staphylococus lugdunensis should raise concerns for [[endocarditis]] with a single positive blood culture<ref>Liu Po-Yen et al. Staphylococcus lugdunensis Infective Endocarditis: A Literature Review and Analysis of Risk Factors. Journal of Microbiology, Immunology and Infection
Volume 43, Issue 6, December 2010, Pages 478-484.</ref>
**[[Staph haemolyticus]]
***Rare cause of [[endocarditis]], [[meningitis]]

===Chains or Pairs ([[Strep Species]] and Related)===
*Enterococcus (e.g. [[Enterococcus faecalis]], [[Enterococcus faecium]]) 
**May cause bacteremia in the proper clinical setting ([[UTI]], intra-abdominal infections, infected vascular catheters, and [[endocarditis]])<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
*[[Strep viridans]]
**In general are low virulence pathogens and likely contaminants (21-50% of positive blood cultures are clinically significant)
**Risk factors for VGS bacteremia include: neutropenia, oral mucositis, irradiation to the oral cavity, antibiotic prophylaxis with trimethoprim-sulfamethoxazole and fluoroquinolones, intravenous hyperalimentation, high dose chemotherapy
*[[Streptococcus pneumoniae]] (Pairs)
**Asociated with [[pneumonia]], [[meningitis]], peritonitis and other severe infections
**Isolation of this organism is always significant and should be treated<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
*Other [[Strep Species]]
**ß-hemolytic streptococcus (Group A Streptococcus, Group B Streptococcus, etc)

==Rods (Bacilli)==
{| border="1" width="453"
|-
| '''Organism'''
| '''<br/>'''
| '''Cult'''
| '''Morphology'''
|-
| 
[[Listeria monocytogenes]]

| 
Small

| Aero<br/>
| tumbling<br/>
|-
| Diphtheroids<br/>
| Small
| Anaero<br/>
| pallisades<br/>
|-
| Actinomyces<br/>
| Small
| Anaero<br/>
| Branching<br/>
|-
| Propionibac<br/>
| Small
| Anaero<br/>
| clumps/pleo<br/>
|-
| Lactobacillus<br/>
| Variable
| Both<br/>
| may chain<br/>
|-
| Clostridium<br/>
| Large
| Anaero<br/>
| Spores<br/>
|-
| Bacillus
| Large
| Aero
| Spores
|}

==[[Antibiogram]]==
{{Template:Gram Positive Antibiogram}}

==Clinical Identification Chart==
[[File:Gram-Positive_Classification.png]]

==Table Overview==
{{Clinically Relevant Bacteria}}

==See Also==
*[[Microbiology (Main)]]
*[[Bacteremia Versus Contaminated Blood Cultures‎]]

==References==
<references/>
[[Category:ID]]