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Antibiotic Therapy Based on Stained Peripheral Blood Smear-Reply

Salvador Alvarez-Elcoro, MD
Arch Intern Med. 1985;145(2):369. doi:10.1001/archinte.1985.00360020213046.
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—I agree with Drs Johnson and Wagner that the clinician should be aware of the presence of other potential pathogens with similar morphology such as Corynebacterium sp, Bacillus sp, Listeria sp, and Erysipelothrix sp. However, in the presence of gram-positive rod bacteremia, Gram's stain usually can differentiate between the large gram-positive rods (clostridium and bacillus) and small rods (Listeria, Corynebacterium and Erysipelothrix) plus the clinical data from the patient involved. The broad-spectrum antibiotic coverage of grampositive rod bacteremia should include penicillin and vancomycin, since all the multiresistant strains of Corynebacterium sp isolated from clinical specimens were uniformly susceptible to vancomycin but resistant to aminoglycosides.1 This combination of antibiotics includes coverage for the other gram-positive rods mentioned.2,3


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