Background: Ventilator-associated pneumonia refers to pneumonia that happens at least 48 hours after endotracheal intubation or tracheostomy with no evidence of pneumonia at the time of intubation. It is associated with high economic costs, longer attributable lengths of stay in the hospital, and high mortality, especially when lung infection is caused by high-risk pathogens. Objective: To determine the incidence and identify determinants of ventilator-associated pneumonia among adult intensive care unit admitted patients at Tibebe Ghion and Felege Hiwot specialized hospitals,Bahirdar Ethiopia,2021. Methods:A retrospective follow-up study was conducted among 312 randomly selected adult intensive care unit admitted patients since April 2019 to September 2021. A data extraction checklist was used to collect data. The collected data were coded, entered, and cleaned in EpiData version 3.1 and exported to STATA version 14 for analysis.Descriptive analysis was done by using frequency tables, percentages, median and inter-quartile range. Bivariable and multiple variable log binomial analyses were made to identify predictors of ventilator-associated pneumonia. Results: The study found that 27.9 %(95% CI: 23% -33%) of patients developed ventilator associated pneumonia during their intensive care unit stay. The incidence rate of ventilator associated pneumonia were 45.7 per 1000 ventilator days. length of patients on mechanical ventilator (ARR: 1.24, 95 % CI: 1.17 - 1.31), Blood transfusion (ARR: 2.78, 95 % CI: 1.13 - 6.86), Low GCS (ARR: 2.5, 95% CI: 1.27 - 5.1), corticosteroid/s use (ARR: 2.14, 95% CI: 1.1 – 4.1), and Supine head position (ARR: 8.1, 95% CI: 1.66 - 39.6) were identified as independent risk factors for the development of Ventilator associated pneumonia. Conclusion and Recommendation: The incidence of Ventilator-associated pneumonia in this study was found to be 27.9 %. The risk factors identified with the development of VAP were ventilation duration,blood transfusion,corticosteroid use, supine head position and low Glasgow coma scale. Further a prospective multicenter study by incorporating additional predictor variables and validation of disease incidence and its risk factors identified in this study is necessary. Keywords: Ventilator-Associated Pneumonia, determinants, Intensive Care Unit