The low sensitivity of direct smears limit the utility of intraoperative gram stains for predicting culture-positivity in acute surgical settings.

The role of intraoperative Gram stains in acute surgery decision-making is unclear. Our retrospective chart review of microbiology results for specimens submitted by acute surgery attendings showed Gram stain performs with a sensitivity ranging from 18% to 65% compared to culture, depending on organism type, thus limiting its utility.