• Y Katayama, H Minami, M Enomoto, T Takano, S Hayashi, and Y K Lee.
• Division of Neonatology, Department of Pediatrics, Takatsuki General Hospital, Takatsuki City, Osaka, Japan. yoshinoli@nifty.com
• J Perinatol. 2010 Apr 1; 30 (4): 270-4.

ObjectiveTo 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 DesignA prospective study was conducted on all episodes of presumed VAP in neonates with a gestational age below 28 weeks at birth.ResultGram-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.ConclusionGram 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.

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