Step 1: Ventilator associated pneumonia (VAP) develops more than 48 hours after intubation and is dominated by hospital-acquired, often multidrug-resistant organisms.
Step 2: Staphylococcus aureus and Pseudomonas aeruginosa together account for most VAP cases. Taken as a single most common organism, Pseudomonas aeruginosa leads at about 21 percent, just ahead of Staphylococcus aureus at about 20 percent.
Step 3: Other frequent VAP organisms are Enterobacter, Klebsiella pneumoniae and Acinetobacter (remember the ESKAPE group). Legionella, pneumococcus and coagulase negative staphylococcus are not the leading causes of VAP.
Step 4: The correct answer is option 3, Pseudomonas.