Inappropriate treatment has clearly been associated with increased mortality and healthcare costs ( 6, 7) and MDR pathogens have been associated with inappropriate initial treatment, leading to a vicious cycle ( 8). A dry pipeline for years, led to the belief that we are approaching вЂњthe end of antibioticsвЂќ ( 5). These pathogens harbor a variety of mechanisms that confer resistance to antibiotics, rendering sometimes infections untreatable ( 4, 5). Gram-negative pathogens and particularly Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii have progressively become predominant, the latter being more prevalent in patients with ventilator-associated pneumonia (VAP) ( 3). Hospital-acquired pneumonia (HAP) remains one of the most important hospital-acquired infections, being associated with significant mortality, morbidity and increase in health expenditures ( 1, 2). Keywords: Ventilator-associated pneumonia multidrug resistant bacteria new antibiotics Acinetobacter baumannii Pseudomonas aeruginosa Carbapenem resistant Enterobacteriaceae Targeted pharmacokinetic and clinical studies in real-life scenario of VAP are important to position these new agents in clinical practice, whereas vigilant use will ensure their longevity in our armamentarium. In summary, despite persisting and increasing unmet medical needs, several newly approved and forthcoming agents hold promise for the treatment of VAP and hopefully will enrich our antimicrobial arsenal in the next few years. Eravacycline, cefiderocol and probably plazomicin seem to be the most promising agents against this difficult-to treat pathogen, but we have still a long road ahead, to see their position in clinical practice and particularly in VAP. Finally, Acinetobacter baummannii remains a treatment-challenge. Murepavadin and cefiderocol hold promise against this particularly notorious pathogen. Against infections caused by carbapenem non-susceptible Pseudomonas aeruginosa, ceftolozane/tazobactam and to a lesser extend ceftazidime/avibactam may cover a proportion of current medical needs, but there still remain a considerable proportion of strains which harbor other resistance mechanisms. Among recently developed antimicrobials presented herein, it is obvious that we will have promising therapeutic options against VAP caused by Enterobacteriaceae excluding those producing metallo-ОІ-lactamases, against which only cefiderocol and aztreonam/avibactam are expected to be active. The aim of this review is to analyse new therapeutic options from the point view of potential treatment of VAP. Development of antimicrobials against MDR Gram-negative pathogens has therefore emerged as a priority and some new antibiotics have been marketed or approach late stage of development. As management of VAP requires adequate and timely antibiotic administration, global emergence of antimicrobial resistance poses serious challenges over our ability to maintain this axiom. Abstract: Ventilator-associated pneumonia (VAP) remains an important clinical problem globally, being associated with significant morbidity and mortality.

Monobactam mechanism pbp3