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increasing antibiotic resistance bacteria causing endogenous infections entailed need innovative approaches therapy prophylaxis infections raised new interest vaccines prevention colonization infection typically antibiotic resistant pathogens nevertheless long history failures late stage clinical development type vaccines remains fully understood article provides overview present past vaccine developments targeting nosocomial bacterial pathogens highlights specific challenges associated demonstrating clinical efficacy vaccines facts considered future study designs notably vaccines mainly applied subjects preexistent immunity target pathogen transient chronic immunosuppression illdefined microbiome status unpredictable attack rates changing epidemiology well highly variable genetic immunological strain characteristics complicate development views clinical need rethinking study designs expectations seems warranted first vaccine development needs footed clear rationale choosing immunological mechanism action optimal time point vaccination eg 1 prevention reduction colonization vs prevention infection 2 boosting preexistent immune response vs altering quality immune response furthermore different probably redundant immunological microbiological defense mechanisms provide protection infection interplay wellunderstood consequence effect might superimpose vaccinemediated resolution infection lead failure demonstrate efficacy implies improved characterization patient subpopulations within trial population obtained pro retrospective analyses trial data subject level statistical systems biology approaches could help define immune microbiological biomarkers discern populations benefit vaccination vaccines might effective