Gram staining can reduce multiple drug-resistant infection in critically ill patients; JAMA

Japan: In patients with ventilator-associated pneumonia (VAP), gram stain-guided therapy was non-inferior to guideline-based treatment and dramatically decreased the usage of broad-spectrum antibiotics, says an article published in the Journal of American Medical Association.

Gram staining should offer quick results for identifying causal organisms. However, the influence of Gram staining on reducing the first antibiotic choice in intensive care units has not been studied (ICUs). As a result, Jumpei Yoshimura and colleagues undertook this study to assess the clinical response of Gram stain-guided restriction guideline-based broad-spectrum antibiotic therapy vs antibiotic therapy in patients with VAP.

From April 1, 2018, to May 31, 2020, this multicenter, open-label, noninferiority randomized clinical study was undertaken in the ICUs of 12 tertiary referral institutions in Japan. Patients aged 15 and up with a VAP diagnosis and a modified Clinical Pulmonary Infection Score of 5 or above were eligible. The population for the primary analysis was based on the per-protocol analysis population. Patients were randomly assigned to either Gram stain–guided antibiotic treatment or antibiotic therapy based on guidelines. The primary endpoint was the clinical response rate; the adverse event was defined as reaching the end of antibiotic therapy within 14 days, betterment or lack of advancement of baseline radiographic findings, resolution of pneumonia signs and symptoms, and absence of antibiotic agent re-administration, with a non-inferiority margin of 20%.