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.