الفهرس 
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Abstract
Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs) and is associated with increased mortality, use of antimicrobials, longer mechanical ventilation, and higher healthcare costs In clinical practice, VAP diagnosis relies usually on a microbiological sample of distal airways. However, reliability of these samples for differentiating lung parenchyma invasion from lower airway colonization is still debated. Moreover a sample requires 24 to 48 hours for preliminary/definitive results. To this day, there is no consensus in early VAP diagnosis; deciding whether to treat a patient is often subjective and debated within teams when a VAP is clinically suspected on the basis of clinical, biochemical and imaging parameters. In such patients, inappropriate or delayed antibiotics lead to higher mortality. On the other hand, overexposure to antibiotic also results in increased morbidity and mortality and is responsible for the emergence of bacterial resistance. Therefore, an accurate and early diagnosis of VAP is crucial to reach the optimal balance between mortality reduction and multi-drug resistance prevention. In this study, 100 patients of clinically suspected VAP according to Simplified Clinical Pulmonary Infectious Score exceeding 6 were included. All the patients were subjected to full clinical history, complete clinical examination and full laboratory investigations. Lung ultrasound scan was taken for all patients in six areas for each lung (superior and inferior areas in the anterior, lateral, and posterior fields using anterior and posterior axillary lines as landmarks). Both usual endotracheal aspirate and protected endotracheal aspirates were taken for gram stain and culture. Bronchoalveolar lavage was taken for both qualitative and quantitative culture. At inclusion, we calculated CPIS, gathered fiberoptic BAL specimens, and sampled endotracheal aspirates (EA) for direct gram stain culture; LUS, BAL, and EA were all performed within 24 h. The results of the study revealed the following:More than half of them were males (63%), with the mean age 61.64±9.36.The patients were divided into two groups: VAP group including 87 patients and non VAP group including 13 patients, according to quantitative culture of bronchoalveolar lavage which was used as the gold standard for diagnosis.