Antimicrobial Stewardship For Ventilator Associated Pneumonia in Intensive Care

Inclusion Criteria: * Diagnosis of microbiologically confirmed of first episode of VAP * Initial appropriate antibiotic therapy (whether empirical or not) * Written informed consent from the patient or a legal representative if appropriate. If absence of a legal representative the patient may be included in emergency procedure Definitive diagnosis of pneumonia (in agreement with international guidelines) is defined by association: * Patient under MV\>48 hours at the time of the microbiological sampling * New pulmonary infiltrate of which an infectious origin is strongly suspected * Worsening oxygenation * Have the following clinical criteria within the 24 hours prior to the first dose of antibiotic therapy * Purulent tracheal secretions * And at least 1 of the following : documented fever (body temperature \>38,3°C) or hypothermia (body temperature \<35°C) or white blood cell (WBC) count \>10,000 cells/mm3 or \<4,000 cells/mm3 * Microbiological criteria (positive quantitative culture of a lower respiratory tract (LRT): bronchoalveolar lavage fluid (BAL) (significant threshold ≥10\^4 colony-forming units/mL) or plugged telescopic catheter (PTC) (significant threshold ≥ 10\^3 colony-forming units/mL) or quantitative endotracheal aspirate (ETA) distal pulmonary secretion samples (significant threshold ≥10\^5 colony-forming units/mL) Exclusion Criteria: * Patient under selective decontamination of the digestive tract * Duration of antibiotic therapy prior to inclusion \> 72h (for any reason) appropriate to the germs found in the bacterial documentation of the first episode of VAP * Inclusion in another interventional study concerning antimicrobial strategies * Moribund (IGS II\>80) * Thoracic trauma with Abbreviated Injury Scale (AIS) thorax ≥ 3 * Severely immunocompromised patients (such as congenital immunodeficiency, neutropenia (\<1leucocyte/ml or \<0.5 neutrophil/ml) or acute hematologic malignancy or stem cell transplant, HIV infection with CD4 count below 200/mm3 * Patients undergoing immunosuppressive therapy and long term corticotherapy \> 0.5 mg/kg * VAP due to: Pseudomonas aeruginosa, Carbapenem-resistant Acinetobacter spp, Carbapenem-resistant Enterobacteriaceae * VAP occurring in the context of co-infection of COVID-19 or other viral pneumonia (confirmed by RT-PCR) * Patients with empyema, necrotizing and abscessed pneumonia * Patients requiring extracorporeal oxygen therapy (ECMO), either veno-venous or veno-arterial * Pregnant women * No health insurance coverage