PURPOSE OF REVIEW: Despite important geographical variations, Enterococcus 
faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, 
Pseudomonas aeruginosa and Enterobacter species (ESKAPE) pathogens constitute 
more than 80% of ventilator-associated pneumonia (VAP) episodes. Their clinical 
importance relies on their virulence and ability in developing mechanisms to 
decrease susceptibility to antimicrobials, increasing inappropriate therapy and 
affecting negatively on ICU patients' outcome. This review updates information 
on VAP due to ESKAPE pathogens.
RECENT FINDINGS: Although methicillin-resistant Staphylococcus aureus VAP may be 
clinically similar to that caused by susceptible strains, it is associated with 
poorer outcomes despite adequate treatment. Local colonization determines 
treatment options. The contribution of tracheobronchitis is an important issue. 
Minimum inhibitory concentration should be considered for nonfermentative 
Gram-negative bacteria VAP to prescribe extended infusion β-lactam treatment due 
to an increase of resistant strains. Strategies promoting antimicrobial 
diversity may protect against emergence and spread of resistance by ESKAPE 
pathogens.
SUMMARY: VAP due to ESKAPE pathogens represents a global challenge that can be 
prevented using stewardship programmes promoting diversity.