Can Gram staining be a guiding tool for optimizing initial antimicrobial agents in bacterial infections?
Jumpei YoshimuraHiroshi OguraJun OdaPublished in: Acute medicine & surgery (2023)
The emergence of multidrug-resistant organisms poses a significant threat to global public health, making the optimization of antimicrobial use crucial. Antimicrobial therapy is often initiated in emergency rooms (ERs) and intensive care units (ICUs), where patients are at high risk of infection. Prompt antimicrobial selection is essential in these facilities, and point-of-care testing can guide the appropriate initial antimicrobial therapy. Gram staining, a quick and inexpensive method, was previously used for point-of-care testing by physicians in the 1980s but was discontinued in 1988 in the United States. However, in Japan, the clinical practice of Gram stain-based antimicrobial therapy by physicians has continued in a limited number of hospitals. Several studies undertaken in Japan have shown that Gram staining carried out by trained physicians can reduce the overuse of broad-spectrum antimicrobial agents in ERs and ICUs without worsening patients' outcomes. Gram stain-based antimicrobial therapy reduced unnecessary use of carbapenems in the ER. Furthermore, Gram staining has been shown to significantly reduce the overuse of broad-spectrum antimicrobials without worsening clinical cure and mortality for patients with ventilator-associated pneumonia in the ICU. The classic technique of Gram staining has regained its usefulness through persistent clinical practice in Japan. It is hoped that Japanese researchers in this field will demonstrate to the world the efficacy of the classic technique of Gram staining in addressing this critical problem. Gram staining carried out by trained physicians could serve as a valuable means of optimizing antimicrobial treatment in ERs and ICUs.
Keyphrases
- gram negative
- multidrug resistant
- staphylococcus aureus
- public health
- primary care
- clinical practice
- end stage renal disease
- drug resistant
- intensive care unit
- acinetobacter baumannii
- healthcare
- newly diagnosed
- emergency department
- chronic kidney disease
- type diabetes
- cystic fibrosis
- cardiovascular disease
- metabolic syndrome
- patient reported outcomes
- peritoneal dialysis
- klebsiella pneumoniae
- skeletal muscle
- adipose tissue
- mechanical ventilation
- coronary artery disease
- mesenchymal stem cells
- resistance training
- high intensity
- insulin resistance
- bone marrow
- breast cancer cells
- acute respiratory distress syndrome