Development of new or progressive infiltrate in the chest X-ray along with fever and leukocytosis after 48 hours of intubation and invasive ventilation is suggestive of ventilator-associated pneumonia (VAP). This occurs in 9–27% of intubated patients and the risk increases with the duration of mechanical ventilation. In India, the difference between microbiological etiology of early onset or late onset does not hold good and VAP is commonly caused by multi-drug resistant (MDR) gram-negative bacilli (GNB) like Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter, and Staphylococcus aureus.