Hellyer TP, McAuley DF, Walsh TS, et al. - Researchers investigated if antibiotic stewardship in patients with clinically suspected ventilator-associated pneumonia can be improved in a safe and effective manner by measuring bronchoalveolar lavage fluid IL-1β and IL-8. For this purpose, they undertook a multicentre, randomised controlled trial, the VAPrapid2 trial, involving patients from 24 ICUs from 17 National Health Service hospital trusts across England, Scotland, and Northern Ireland. The eligible patients were randomly allocated (1:1) to biomarker-guided advice on antibiotics (intervention group) or routine use of antibiotics (control group). Findings revealed high antibiotic use among patients with suspected ventilator-associated pneumonia, as well as the inability of a rapid, highly sensitive rule-out test to bring about an improvement in antibiotic stewardship. This absence of effect might be explained by prescribing culture, rather than poor test performance.