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. Journal of Perinatology (2010) 30, 270-274; doi: 10.1038/jp.2009.144; published online 1 October 2009