Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in critically ill patients and the incidence of resistance among organisms causing VAP is increasing. Therefore, the management requires a strategy that achieves accurate empiric cover without antibiotic overuse – a goal that can be achieved by microbiological surveillance and antibiotic stewardship Aims: With the objective of optimising the treatment policy for VAP and reducing the resistance and improving patient outcome, the study at Shree Krishna Hospital, Karamsad, is employed with three aims: (i) to look for the burden of VAP in medical critical care unit; (ii) to study the bacteriological profile in VAP and the antibiotic sensitivity pattern of organism isolates in patients with VAP and (iii) to ascertain how frequently the initial empirical antibiotic was appropriate as per the epidemiological profile. Settings and Design: All patients admitted over a period of 1 year to medical critical care unit and were on mechanical ventilator for more than 48 hours were studied. Methods and Material: Over a 12 month period, all patients admitted to medical critical care unit and underwent mechanical ventilation for more than 48 hours were identified from a prospectively gathered database. Among these, patients who developed VAP as per the CPIS score were identified. For each patient, bacterial isolates and antimicrobial susceptibility were identified using standard laboratory techniques. Empiric prescriptions for presumed ventilator-associated pneumonia were identified from the hospital’s patient record system and compared with culture results. Statistical analysis used: t-test was used to compare continuous variable. Chi-square test was used to compare categorical variables. Results: Of the 116 patients, 59 (51.9%) developed VAP. From these, Acinetobacter baumannii was most common organism isolated in 62.7% cases followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, E. coli, Staphylococcus aureus, Acinetobacter lowfii and Staphylococcus hemolyticus. Acinetobacter baumannii, the most common organism isolated, was sensitive only to colistin in 94.6% cases and in 5% sensitive to carbapenems along with colistin and in less than 1% cases sensitive to other antibiotics. Other organisms isolated also had similar resistance pattern with minor variations. 90% of patients’ empirical antibiotics as per current antibiotic policy required change of antibiotic after culture reports.