Dear Editor, We thank the authors for the interest in our recent publication and for their useful comments. Unfortunately we consider the comparison with the publication from Giannella et al1 poorly appropriate in many aspects. The main strength of our work is the multicentre prospective case–control study design (match by age, gender and period of hospitalisation). Although severity scores were not used for matching, we considered this design the most appropriate to describe healthcare-associated pneumonia (HCAP) features. In fact, the Giannella group performed an observational prospective study only on patients admitted to internal medicine departments: these elements (study design and patients) could justify a different population composition and, consequently, different microbiological and clinical findings. In fact, in comparison...