The results of a randomized clinical trial conducted in Japan indicate that Gram stain–guided antibiotic therapy could help safely reduce the use of broad-spectrum antibiotics in patients who have ventilator-associated pneumonia (VAP).

The results, published last week in JAMA Network Open, showed that Gram stain–guided antibiotic treatment in VAP patients yielded non-inferior clinical responses to guideline-based treatment, while significantly reducing the use of antipseudomonal and anti-methicillin resistant Staphylococcus aureus (MRSA) antibiotics.

A Gram stain is an inexpensive, simple test—invented by Danish bacteriologist Hans Christian Gram in 1884—that uses samples from the site of an infection to determine whether the infection is caused by gram-positive bacteria (signified by a purple stain) or gram-negative (a red or pink stain). The test is used worldwide to guide initial antibiotic therapy for a variety of bacterial infections, but questions have remained about whether it is accurate enough to safely restrict broad-spectrum antibiotic use.

The investigators wanted to test this technique for suspected pneumonia patients, including VAP, because of concerns that current treatment guidelines result in overuse of broad-spectrum agents, which can promote antibiotic resistance.

They say the results suggest that use of the "time-honored" Gram stain technique may be a better option than more expensive molecular point-of-care tests for optimizing antibiotic choice in pneumonia and slowing the spread of multidrug-resistant (MDR) bacteria.

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