hemolysis. Some manual blood culture systems indicate growth using a compartment that fills with fluid when gases are produced, or a miniature agar plate which is periodically inoculated by tipping the bottle. To ensure that positive blood cultures are not missed, a sample from the bottle is often inoculated onto an agar plate (subcultured) at the end of the incubation period regardless of whether or not indicators of growth are observed. In developed countries, manual culture methods have largely been replaced by automated systems that provide continuous computerized monitoring of the culture bottles. These systems, such as the BACTEC, BacT/ALERT and VersaTrek, consist of an incubator in which the culture bottles are continuously mixed. Growth is detected by sensors that measure the levels of gases inside the bottle—most commonly carbon dioxide—which serve as an indicator of microbial metabolism. An alarm or a visual indicator alerts the microbiologist to the presence of a positive blood culture bottle. If the bottle remains negative at the end of the incubation period, it is generally discarded without being subcultured. A technique called the lysis-centrifugation method can be used for improved isolation of slow-growing or fastidious organisms, such as fungi, mycobacteria, and Legionella. Rather than incubating the blood in a bottle filled with growth medium, this method involves collecting blood into a tube containing an agent that destroys (lyses) red and white blood cells, then spinning the sample in a centrifuge. This process concentrates the solid contents of the sample, including microorganisms if present, into a pellet, which is used to inoculate the subculture media. While lysis-centrifugation offers greater sensitivity than conventional blood culture methods, it is prone to contamination because it requires extensive manipulation of the sample. Identification If growth is detected, a microbiologist will perform a Gram stain on a sample of blood from the bottle for a rapid preliminary identification of the organism. The Gram stain classifies bacteria as Gram-positive or Gram-negative and provides information about their shape—whether they are rod-shaped (referred to as bacilli), spherical (referred to as cocci), or spiral-shaped (spirochetes)—as well as their arrangement. Gram-positive cocci in clusters, for example, are typical of Staphylococcus species. Yeast and other fungi may also be identified from the Gram stain. A Gram stain identifying microbial growth from a blood culture is considered a critical result and must immediately be reported to the clinician. The Gram stain provides information about the possible identity