Yoshimura Jumpei, Ogura Hiroshi, Oda Jun
Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan.
Acute Med Surg. 2023 Jun 24;10(1):e862. doi: 10.1002/ams2.862. eCollection 2023 Jan-Dec.
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.
多重耐药菌的出现对全球公共卫生构成了重大威胁，因此优化抗菌药物的使用至关重要。抗菌治疗通常在急诊室（ER）和重症监护病房（ICU）启动，这些地方的患者感染风险很高。在这些科室中，迅速选择抗菌药物至关重要，即时检测可以指导适当的初始抗菌治疗。革兰氏染色是一种快速且廉价的方法，在20世纪80年代曾被医生用于即时检测，但在1988年在美国停止使用。然而，在日本，少数医院的医生仍在继续基于革兰氏染色的抗菌治疗临床实践。日本进行的多项研究表明，经过培训的医生进行革兰氏染色可以减少急诊室和重症监护病房中广谱抗菌药物的过度使用，而不会使患者的病情恶化。基于革兰氏染色的抗菌治疗减少了急诊室中碳青霉烯类药物的不必要使用。此外，对于重症监护病房中患有呼吸机相关性肺炎的患者，革兰氏染色已被证明可以显著减少广谱抗菌药物的过度使用，而不会恶化临床治愈率和死亡率。通过在日本的持续临床实践，革兰氏染色的经典技术重新获得了实用性。希望该领域的日本研究人员能向世界展示革兰氏染色经典技术在解决这一关键问题上的功效。经过培训的医生进行革兰氏染色可以成为优化急诊室和重症监护病房抗菌治疗的宝贵手段。
