Figure 2

Flowchart for identifying cocci in chains. After morphology was determined by Gram staining, subcultures were performed on blood, chocolate and esculin agar plates. Samples from positive blood culture bottles were then tested first with Oxoid Dryspot Pneumo Test and then Prolex Lancefield agglutination tests. When colonies were visible, agglutinations were performed again and esculin positivity and well as PYR tests (positive for GAS and enterococci) were included in the results. The following day complementary tests were read, e.g. API for ambiguous gram-positive cocci, optochin /bacitracin susceptibility for pneumococci and group A streptococci respectively and CAMP for Group B streptococci, which is positive by detecting haemolysis by an indicator strain of S. aureus, which takes place in the presence of a factor produced by GBS. Abbreviations in the figure: Prel.: preliminary, strep: streptococci, ent: enterococci, pneu.: pneumococci, GAS/GBS/GCS/GFS/GGS: group A/B/C/F/G streptococci, PYR: L-pyrrolidonyl-ß-naphthylamide-test, CAMP: a test for GBS identification, API: analytical profile index, a commercial phenotypic test for species determination.