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A Gram stain of mixed Staphylococcus aureus (S. aureus ATCC 25923, gram-positive cocci, in purple) and Escherichia coli (E. coli ATCC 11775, gram-negative bacilli, in red), the most common Gram stain reference bacteria

Gram stain or Gram staining, also called Gram's method, is a method of staining used to distinguish and classify bacterial species into two large groups (gram-positive and gram-negative). The name comes from the Danish bacteriologist Hans Christian Gram, who developed the technique.

Gram staining differentiates bacteria by the chemical and physical properties of their cell walls by detecting peptidoglycan, which is present in the cell wall of Gram-positive bacteria. Gram-negative cells also contain peptidoglycan, but a very small layer of it that is dissolved when the alcohol is added. This is why the cell loses its initial color from the primary stain.^[1] Gram-positive bacteria retain the crystal violet dye, and thus are stained violet, while the Gram-negative bacteria do not; after washing, a counterstain is added (commonly safranin or fuchsine) that will stain these Gram-negative bacteria a pink color. Both Gram-positive bacteria and Gram-negative bacteria pick up the counterstain. The counterstain, however, is unseen on Gram-positive bacteria because of the darker crystal violet stain.

The Gram stain is almost always the first step in the preliminary identification of a bacterial organism. While Gram staining is a valuable diagnostic tool in both clinical and research settings, not all bacteria can be definitively classified by this technique. This gives rise to gram-variable and gram-indeterminate groups.

History

The method is named after its inventor, the Danish scientist Hans Christian Gram (1853–1938), who developed the technique while working with Carl Friedländer in the morgue of the city hospital in Berlin in 1884. Gram devised his technique not for the purpose of distinguishing one type of bacterium from another but to make bacteria more visible in stained sections of lung tissue.^[2] He published his method in 1884, and included in his short report the observation that the typhus bacillus did not retain the stain.^[3]

Uses

Gram staining is a bacteriological laboratory technique^[4] used to differentiate bacterial species into two large groups (gram-positive and gram-negative) based on the physical properties of their cell walls.^{[5][page needed]} Gram staining is not used to classify archaea, formerly archaeabacteria, since these microorganisms yield widely varying responses that do not follow their phylogenetic groups.^[6]

The Gram stain is not an infallible tool for diagnosis, identification, or phylogeny, and it is of extremely limited use in environmental microbiology. It is used mainly to make a preliminary morphologic identification or to establish that there are significant numbers of bacteria in a clinical specimen. It cannot identify bacteria to the species level, and for most medical conditions, it should not be used as the sole method of bacterial identification. In clinical microbiology laboratories, it is used in combination with other traditional and molecular techniques to identify bacteria. Some organisms are gram-variable (meaning they may stain either negative or positive); some are not stained with either dye used in the Gram technique and are not seen. In a modern environmental or molecular microbiology lab, most identification is done using genetic sequences and other molecular techniques, which are far more specific and informative than differential staining.

Gram staining has been suggested to be as effective a diagnostic tool as PCR in one primary research report regarding gonococcal urethritis.^{[7][non-primary source needed]}

Medical

Gram stains are performed on body fluid or biopsy when infection is suspected. Gram stains yield results much more quickly than culturing, and is especially important when infection would make an important difference in the patient's treatment and prognosis; examples are cerebrospinal fluid for meningitis and synovial fluid for septic arthritis.^[4][8]

Staining mechanism

(Left to right) Purple stained Gram-positive and pink stained Gram-negative

Gram-positive bacteria have a thick mesh-like cell wall made of peptidoglycan (50–90% of cell envelope), and as a result are stained purple by crystal violet, whereas gram-negative bacteria have a thinner layer (10% of cell envelope), so do not retain the purple stain and are counter-stained pink by safranin. There are four basic steps of the Gram stain:

• Applying a primary stain (crystal violet) to a heat-fixed smear of a bacterial culture. Heat fixation kills some bacteria but is mostly used to affix the bacteria to the slide so that they don't rinse out during the staining procedure.


• The addition of iodide, which binds to crystal violet and traps it in the cell


• Rapid decolorization with ethanol or acetone
  


• 
  Counterstaining with safranin.^[9]Carbol fuchsin is sometimes substituted for safranin since it more intensely stains anaerobic bacteria, but it is less commonly used as a counterstain.^[10]
  

Crystal violet (CV) dissociates in aqueous solutions into CV⁺
and chloride (Cl⁻
) ions. These ions penetrate through the cell wall and cell membrane of both gram-positive and gram-negative cells. The CV⁺
ion interacts with negatively charged components of bacterial cells and stains the cells purple.^[11]

Iodide (I⁻
or I⁻
₃) interacts with CV⁺
and forms large complexes of crystal violet and iodine (CV–I) within the inner and outer layers of the cell. Iodine is often referred to as a mordant, but is a trapping agent that prevents the removal of the CV–I complex and, therefore, color the cell.^[12]

When a decolorizer such as alcohol or acetone is added, it interacts with the lipids of the cell membrane.^[13] A gram-negative cell loses its outer lipopolysaccharide membrane, and the inner peptidoglycan layer is left exposed. The CV–I complexes are washed from the gram-negative cell along with the outer membrane.^{[14][citation needed]} In contrast, a gram-positive cell becomes dehydrated from an ethanol treatment. The large CV–I complexes become trapped within the gram-positive cell due to the multilayered nature of its peptidoglycan.^{[14][citation needed]} The decolorization step is critical and must be timed correctly; the crystal violet stain is removed from both gram-positive and negative cells if the decolorizing agent is left on too long (a matter of seconds).^{[15][citation needed]}

After decolorization, the gram-positive cell remains purple and the gram-negative cell loses its purple color.^{[15][citation needed]} Counterstain, which is usually positively charged safranin or basic fuchsine, is applied last to give decolorized gram-negative bacteria a pink or red color.^[16][17]

Examples

Gram-positive bacteria

Gram-positive bacteria generally have a single membrane (monoderm) surrounded by a thick peptidoglycan.
This rule is followed by two phyla: Firmicutes (except for the classes Mollicutes and Negativicutes) and the Actinobacteria.^[5][18] In contrast, members of the Chloroflexi (green non-sulfur bacteria) are monoderms but possess a thin or absent (class Dehalococcoidetes) peptidoglycan and can stain negative, positive or indeterminate; members of the Deinococcus-Thermus group, stain positive but are diderms with a thick peptidoglycan.^{[5][page needed][18]}

Historically, the gram-positive forms made up the phylum Firmicutes, a name now used for the largest group. It includes many well-known genera such as Bacillus, Listeria, Staphylococcus, Streptococcus, Enterococcus, and Clostridium.^{[19][citation needed]} It has also been expanded to include the Mollicutes, bacteria like Mycoplasma that lack cell walls and so cannot be stained by Gram, but are derived from such forms.^{[20][citation needed]}

Some bacteria have cell walls which are particularly adept at retaining stains. These will appear positive by Gram stain even though they are not closely related to other gram-positive bacteria. These are called acid fast bacteria, and can only be differentiated from other gram-positive bacteria by special staining procedures.^{[21][citation needed]}

Gram-negative bacteria

Gram-negative bacteria generally possess a thin layer of peptidoglycan between two membranes (diderms). Most bacterial phyla are gram-negative, including the cyanobacteria, green sulfur bacteria, and most Proteobacteria (exceptions being some members of the Rickettsiales and the insect-endosymbionts of the Enterobacteriales).^{[5][page needed][18]}

Gram variable and gram-indeterminate bacteria

Some bacteria, after staining with the Gram stain, yield a gram-variable pattern: a mix of pink and purple cells are seen.^{[14][citation needed]} In cultures of Bacillus, Butyrivibrio, and Clostridium, a decrease in peptidoglycan thickness during growth coincides with an increase in the number of cells that stain gram-negative.^[22] In addition, in all bacteria stained using the Gram stain, the age of the culture may influence the results of the stain.^[23]

Gram-indeterminate bacteria do not respond predictably to Gram staining and, therefore, cannot be determined as either gram-positive or gram-negative. Examples include many species of Mycobacterium, including M. tuberculosis and M. leprae.^[24][25]

Orthographic note

The term 'Gram staining' is derived from the surname of Hans Christian Gram; the eponym (Gram) is therefore capitalized but not the common noun (stain) as is usual for scientific terms.^[26] The adjectives 'gram-positive' and 'gram-negative'; as eponymous adjectives, their initial letter can be either lowercase 'g' or capital 'G', depending on whose style guide (if any) governs the document being written. Lowercase style is used by the US Centers for Disease Control and Prevention and other style regimens such as the AMA style.^[27] Dictionaries may use lowercase,^[28][29] uppercase,^{[30][31][32][33]} or both.^[34][35] Uppercase 'Gram-positive' or 'Gram-negative' usage is also common in many scientific journal articles and publications.^[35][36][37] When articles are submitted to journals, each journal may or may not apply house style to the postprint version. Preprint versions contain whichever style the author happened to use. Even style regimens that use lowercase for the adjectives 'gram-positive' and 'gram-negative' still use capital for 'Gram stain'.

See also

• Bacterial cell structure

References

External links

Wikimedia Commons has media related to Gram stains.

The Wikibook School Science has a page on the topic of: Gram staining

• Gram staining technique video