Iregui et al documented an adverse outcome with initially delayed appropriate antimicrobial therapy in 107 patients with VAP and examined factors leading to such delays (54). Thirty-three patients (30.8%) received appropriate antibiotic treatment that was delayed > 24 hours after patients initially met diagnostic criteria for VAP, often because of a delay in physician recognition of the presence of VAP and writing the orders for antimicrobial treatment (n = 25; 75.8%). Patients receiving delayed antimicrobial treatment had greater hospital mortality compared to patients without the delay (69.7% vs. 28.4%). Delays in the administration of appropriate antibiotic treatment have also recently been associated with greater mortality for patients with severe sepsis, and with greater hospital costs and lengths of stay for patients with VAP (76,77).