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Can empiric broad-spectrum antibiotics for ventilator-associated pneumonia be narrowed based on Gram's stain results of bronchoalveolar lavage fluid.

Kopelman TR

Phoenix, AZ, USA. Tammy_Kopleman@medprodoctors.com <Tammy_Kopleman@medprodoctors.com>

BACKGROUND: Although Gram's stain (GS) of bronchoalveolar lavage fluid is routinely obtained, its usefulness remains unclear. Our purpose was to assess the value of the GS in diagnosing ventilator-associated pneumonia (VAP) and to determine whether early antibiotic narrowing was feasible. METHODS: Retrospective study of critically ill surgical patients with clinical and quantitative evidence of VAP. GS and culture data were collated and analyzed. RESULTS: GS results correlated with cultured organisms in 60% of cases. Overall accuracy of GS in diagnosing VAP for any organism was 58%. Gram-negative rod staining yielded like pneumonia at a statistically higher rate than Gram-positive cocci. A lack of bacteria on GS demonstrated no growth on culture 26.5% of the time, revealing the poorest correlation of all. CONCLUSIONS: GS cannot be a reliable surrogate for quantitative culture. Altering antibiotic therapy based on GS could lead to inappropriate therapy and, presumably, greater morbidity and mortality.

Published 12 December 2006 in Am J Surg, 192(6): 812-6.
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