of the organism, which assists the clinician in the selection of a more appropriate antimicrobial treatment before the full culture and sensitivity results are complete. In traditional methods, the blood is then subcultured onto agar plates to isolate the organism for further testing. The Gram stain results inform microbiologists about what types of agar plates should be used and what tests might be appropriate to identify the organism. In some cases, no organisms are seen on the Gram stain despite the culture bottle showing indicators of growth or being reported as positive by automated instruments. This may represent a false positive result, but it is possible that organisms are present but cannot easily be visualized microscopically. Positive bottles with negative Gram stains are subcultured before being returned to the incubator, often using special culture media that promotes the growth of slow-growing organisms. It typically takes 24 to 48 hours for sufficient growth to occur on the subculture plates for definitive identification to be possible. At this point, the microbiologist will assess the appearance of the bacterial or fungal colonies and carry out tests that provide information about the metabolic and biochemical features of the organism, which permit identification to the genus or species level. For example, the catalase test can distinguish streptococci and staphylococci (two genera of Gram-positive cocci) from each other, and the coagulase test can differentiate Staphylococcus aureus, a common culprit of bloodstream infections, from the less pathogenic coagulase-negative staphylococci. Microorganisms may also be identified using automated systems, such as instruments that perform panels of biochemical tests, or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), in which microbial proteins are ionized and characterized on the basis of their mass-to-charge ratios; each microbial species exhibits a characteristic pattern of proteins when analyzed through mass spectrometry. Because bloodstream infections can be life-threatening, timely diagnosis and treatment is critical, and to this end several rapid identification methods have been developed. MALDI-TOF can be used to identify organisms directly from positive blood culture bottles after separation and concentration procedures, or from preliminary growth on the agar plate within a few hours of subculturing. Genetic methods such as polymerase chain reaction (PCR) and microarrays can identify microorganisms by detection of DNA sequences specific to certain species in blood culture samples. Several systems designed for the identification of common blood culture pathogens are commercially available. Some biochemical and immunologic tests can be performed