The diagnosis of VA-LRTI was based on the presence of at least two of the following criteria: body temperature of more than 38.5 °C or less than 36.5 °C, leucocyte count greater than 12000 cells per μL or less than 4000 cells per μL, and purulent tracheal secretions [4]. Additionally, all episodes of infection needed microbiological confirmation, with the isolation in the endotracheal aspirate of at least 105 colony-forming units (CFU) per mL, or in bronchoalveolar lavage of at least 104 CFU per mL. VAT was defined with the above-mentioned criteria with no radiographic signs of new pneumonia. VAP was defined by the presence of new or progressive infiltrates on chest X-ray. Only first episodes of VAT and VAP occurring more than 48 h after starting invasive mechanical ventilation were analyzed. VAP was defined as occurring subsequently to VAT if it was diagnosed in the 96 h period after diagnosis of VAT and if the same microorganism caused both infections. All VA-LRTI episodes were prospectively identified, and chest X-rays, and other definition criteria were reviewed by at least two attending physicians. In case of disagreement, a third physician was asked to interpret the radiograph.

Antibiotic treatment was considered appropriate when at least one antibiotic, matching the in vitro susceptibility of the pathogen causing VA-LRTI, was administered to treat this infection [17]. Microbiological identification and susceptibility tests were performed using standard methods. Multidrug resistant (MDR) isolates were defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories [18].

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