AIM: The aim of the study was to investigate and delineate the incidence or occurrence of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) of the Department for pulmonary diseases and tuberculosis in the Hospital for pulmonary diseases Klenovnik for the period of two years. METHODS: The study included all patients who were treated and hospitalized in the ICU in the period from January 1 2018. to December 31, 2019, and subsequently developed an early or late pneumonia associated with mechanical ventilation. The data were collected from the hospital information system and available medical documentation. A detailed questionnaire for the data collection was created for this purpose. Data like incidence, demographic characteristics (including gender, age distribution, and duration of mechanical ventilation) were analysed and presented in detail by descriptive statistics. The study also includes the differentiation by causative agents, comparison of VAP between patients hospitalized directly to Klenovnik and those transferred from other wards or institutions, but also treatment outcomes and survival rates. RESULTS: In the period of two years, a total of 185 patients were hospitalized and treated in the ICU, while 70 patients (38 %) underwent mechanical ventilation. A total of 48 patients (69 %) were men, 73% of patients belong to the age group older than 55 years, while 73% of patients were transferred from other wards or institutions. A total of 63 patients (90 %) developed pneumonia with a whopping 92 % classified as late pneumonia caused mainly by MDRO acquired in the hospital environment, with a domination of gram-negative bacteria in more than 80 % of the observed patients. The result of a comparative analysis of antimicrobial drug testing for isolates of Stapyhlococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii (isolated in 74.28 % of patients) were also presented. Finally, fatal outcomes were reported in 76 % of patients with VAP. CONCLUSION: High incidence of development and high mortality rate accompanied with the presence of MDRO pathogens found in mechanically ventilated patients indicates the importance of the described topic. Prevention, timely diagnosis, local microbiological flora knowledge and targeted therapy are pivotal for the successful treatment and reduction of mortality from VAP.