Were bronchoscopy routinely employed to collect specimens from patients suspected of VAP, it would place a potentially untenable time and cost burden on health-care systems. Bronchoscopy, however, does not appear to be routinely necessary. Ruiz et al16found no difference in mortality or antibiotic use when comparing tracheal aspirates (TAs) with bronchoscopically obtained specimens, both of which were cultured quantitatively. However, the study was small, enrolling only 76 patients, and was probably underpowered to detect clinically relevant differences in outcomes. Similarly, Bregeon et al,17in a prospective, case-controlled study comparing outcomes in patients in whom a diagnosis of VAP was made using quantitative cultures obtained from invasively obtained vs noninvasively obtained samples, found no difference in outcomes among 76 pairs of patients matched on several clinical variables. The correlation between quantitatively cultured TA specimens and bronchoscopically collected specimens appears to be good. El-Ebiary and colleagues18 found very good correspondence between these techniques. This has been reconfirmed in the current study by Wu and colleagues in a population that is extraordinarily common in most ICUs: patients already receiving antibiotic therapy. Significantly, quantitative cultures of TA specimens were at least as sensitive and nearly as specific as bronchoscopically obtained specimens. Hence, use of a 105 threshold for TA cultures should minimize the potential for not treating a pneumonia that is present, while maintaining reasonable specificity and permitting the discontinuation of antibiotic therapy in a large number of patients without pneumonia. Further, antibiotic sensitivities of species collected by invasive and noninvasive means were similar, arguing that there will be little difference in antibiotic use patterns or culture-directed changes in antibiotic therapy consequent to the use of one specimen or the other.