Abstract Background:Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after the initiation of endotracheal intubation and mechanical ventilation. It is the most common nosocomial infection among intubated patients. Objectives:This study aimed to determine the prevalence of ventilator-associated pneumonia and identify associated factors among intubated adult patients admitted to TibebeGhion Specialized Hospital, Ethiopia, from Jan2023 to Dec2025.. Methods:An institution-based cross-sectional study was conducted in TGSH, among 314 adult patients who were mechanically ventilated for more than 48 hours. Data were collected through structured medical chart review using a standardized data extraction checklist. Data cleaning done and were entered and analyzed using SPSS software. Bivariable logistic regression was performed to identify candidate variables, and those with a p-value <0.25 were entered into a multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify independent predictors of VAP. A p-value <0.05 was considered statistically significant. Results:The prevalence of ventilator-associated pneumonia (VAP) was 18.2% (95% CI: 13.9–22.4%).In multivariable logistic regression analysis, sedation (AOR = 2.83; 95% CI: 1.26–6.35; p = 0.012), prolonged mechanical ventilation (≥7 days) (AOR = 7.27; 95% CI: 3.39–15.57; p< 0.001), diabetes mellitus (AOR = 3.23; 95% CI: 1.14–9.09; p = 0.027), tracheostomy (AOR = 7.12; 95% CI: 1.92–26.39; p = 0.003), sepsis (AOR = 7.47; 95% CI: 2.52–22.13; p = 0.002), and prior antibiotic use (AOR = 4.14; 95% CI: 1.69–10.16; p = 0.002) were independently associated with ventilator-associated pneumonia. Conclusionandrecommendations:The prevalence of ventilator-associated pneumonia (VAP) was 18.2% (95% CI: 13.9–22.4%) which is lower than the previous study finding. Sedation, prolonged mechanical ventilation, prior antibiotic use, diabetes mellitus, tracheostomy, and sepsis are independent predictors of ventilator-associated pneumonia.Sedation minimization and daily interruption protocols, early weaning and spontaneous breathing trials, strict tracheostomy care and suctioning protocols, antimicrobial stewardship and culture-guided therapy, glycemic control for diabetic patients and early recognition and management of sepsis are recommended.