Introduction Ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia developing in a patient 48 hours after the initiation of mechanical ventilatory support (by endotracheal tube (ETT) or tracheostomy tube) (1). Despite major advances in the techniques for the management of ventilator dependent patients, VAP continues to complicate the course of 8-28% of the patients receiving mechanical ventilation (MV) (1-3). Rates of pneumonia are considerably higher among patients hospitalized in intensive care units (ICUs) compared with those in the hospital wards. The risk of pneumonia is increased 3 to 10 folds for the intubated patient receiving mechanical ventilation (1, 2, 4-6). The mortality with VAP is considerably high, varying from 24 to 50% and can reach as high as 76% in some specific settings or when lung infection is caused by high risk pathogens (1).