Effect of Gram Stain–Guided Initial Antibiotic Therapy on Clinical Response in Patients With Ventilator-Associated Pneumonia

Does Gram stain–guided antibiotic therapy restrict the administration of broad-spectrum antibiotic agents for ventilator-associated pneumonia without detrimental effects on patient outcomes?

In this randomized clinical trial that included 206 patients with ventilator-associated pneumonia in the intensive care unit, the clinical response to Gram stain–guided antibiotic therapy was noninferior to that of guideline-based antibiotic therapy (76.7% vs 71.8%). Gram stain–guided antibiotic therapy reduced the use of antipseudomonal agents and anti–methicillin-resistant Staphylococcus aureus agents.

The findings of this trial suggest that Gram staining can be used in the critical care setting to ameliorate the spread of multidrug-resistant pathogens.