Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated pneumonia in extremely preterm neonates.

OBJECTIVE: To determine the effectiveness of Gram staining of tracheal aspirates for predicting causative microorganisms and guiding appropriate initial antibiotic therapy to treat ventilator-associated pneumonia (VAP) in extremely preterm neonates. STUDY
DESIGN: A prospective study was conducted on all episodes of presumed VAP in neonates with a gestational age below 28 weeks at birth. RESULT: Gram-positive cocci and Gram-negative bacilli were the causative microorganisms in 11 and 38 confirmed episodes of VAP, respectively. The sensitivity and specificity of Gram staining were 82 and 100% for Gram-positive VAP and 100 and 82% for Gram-negative VAP, respectively. The initial antibiotic therapies based on Gram-stain findings were appropriate for 96% (47/49) of patients with VAP.
CONCLUSION: Gram staining of tracheal aspirates is useful in predicting classes of causative microorganisms and for guiding appropriate initial antibiotic therapy for VAP in extremely preterm neonates.