**7. Final considerations**

One of the main problems of VAP is the lack of a gold standard for rapid and reliable diagnosis. Mortality associated with VAP remains high, mainly because of the increasing prevalence of MDR pathogens and their resistance profiles vary depending on the patient group and the hospital setting. However, significant progress has been obtained in the development of systems or platforms for molecular detection of respiratory pathogens, which are feasible to be applied to the routine diagnosis of VAP. Additionally, metabolic profiling of exhaled breath will aim to speed up the process after refinement of the sampling methodology and discovery of highly discriminatory biomarkers. With the validation and implementation of these methods for diagnosis, probably a more adequate control of VAP will be obtained. Especially, because the early and appropriate use of antibiotics may result in reduced mortality among patients under mechanical ventilation. Although, it is important to observe the guidelines for patient management, antibiotic therapy must be based on local prevalence and microbiology data.
