Various Gram staining automated systems are available to accelerate and standardize the staining process, but a systematic comparison of different systems is largely lacking. The objective of this study was to evaluate two devices in comparison to manual Gram staining. Clinical samples (n = 500; University Hospital Münster, Germany; May to June 2020) were simultaneously Gram stained manually and with two automated Gram stainers (Previ Color Gram, bioMérieux, and ColorAX2, Axonlab). The quality was assessed based on four criteria: (i) homogeneous staining of bacteria/fungi, (ii) uniform staining of the background, (iii) absence of staining artifacts, and (iv) congruency between culture and microscopy. Each criterion was rated with 0 (absence) or 1 (presence) point to calculate a quality score (0 to 4 points). The costs for each staining procedure were calculated based on consumables and hands-on time (applying the average wage of a laboratory technician in the public service for Germany and the United States). The mean (± standard deviation [SD]) quality scores were comparable for manual staining (3.06 ± 0.91) and Previ Color Gram (3.04 ± 0.90; P = 0.6), while significantly lower scores were achieved by ColorAX2 (2.57 ± 1.09; P < 0.0001). The total cost per Gram stain was €1.13/$1.34 for Previ Color Gram, €0.80/$0.83 for manual, and €0.60/$0.71 for ColorAX2, respectively. The quality and costs per slide vary significantly between instruments of different manufacturers.

中文翻译：

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革兰氏染色：两种自动化系统和手动染色的比较。

可以使用各种Gram染色自动化系统来加速和标准化染色过程，但是在很大程度上缺乏对不同系统的系统比较。这项研究的目的是评估与手动革兰氏染色相比的两种设备。临床样品（Ñ= 500; 德国明斯特大学医院；2020年5月至2020年6月）同时手动进行了Gram染色，并使用了两个自动Gram染色机（Previ Color Gram，bioMérieux和ColorAX2，Axonlab）进行染色。根据四个标准评估质量：（i）细菌/真菌的均质染色；（ii）背景的均一染色；（iii）没有染色伪影；（iv）培养和显微镜检查之间的一致性。每个标准的评分为0（不存在）或1（存在），以计算质量得分（0到4分）。根据耗材和动手时间（应用德国和美国公共服务实验室技术人员的平均工资）来计算每个染色过程的成本。平均质量（±标准偏差[SD]）质量分数与手工染色相当（3.06±0。P = 0.6），而ColorAX2的得分明显较低（2.57±1.09; P <0.0001）。Previ Color Gram每克革兰染色的总成本分别为1.13欧元/1.34美元，手动印刷每克0.88美元/0.83美元和ColorAX2的0.60欧元/0.71美元。每张幻灯片的质量和成本在不同制造商的仪器之间差异很大。