ABSTRACT Background: Globally, community acquired pneumonia is a common cause of lower respiratory tract infection with high morbidity and mortality. The etiologic agent of community acquired pneumonia and their susceptibility pattern to the different antibiotics varied considerably between different geographical regions, at different time even with the same place. Objective: To assess bacterial isolates and their antimicrobial resistance profile among community acquired pneumonia presumptive adult patients at Felege Hiwot Referral Hospital, North West Ethiopia. Method: A cross-sectional study was conducted between April and July 2018 at Felege Hiwot Referral Hospital. Pre-tested structured questionnaire was used to collect data on the socio-demographic characteristics. Sputum samples were collected and cultured as per the standard procedures. The drug susceptibility testing was performed using Kirby Bauer disk diffusion method. Data entry and analysis was done using SPSS version 23. Bivariate and multivariate analysis was used to determine risk factors and was considered statistically significant when a P-value was less than or equal to 0.05. Result: Out of 414 cases, 167 (40.3%) were found to be culture positive. In this study, Streptococcus pneumoniae 60(35.9%) and Klebsella pneumoniae30(18%) were the most frequently isolated organisms. Out of the 167 isolates, multidrug resistance was observed in 127(76%) isolates. Overcrowded living condition and alcohol use were significantly associated with culture positive community acquired pneumonia. Conclusion: In the studied area, Streptococcus pneumoniae, Klebsella pneumoniae and S.aureus were the most frequently isolated bacteria.Antimicrobial resistance pattern including multidrug resistance was observed to a number of commonly used antibiotics. Therefore, periodic monitoring of the etiologic diagnosis and their antibiotic resistance patterns should be made. Overcrowded living condition and alcohol use were found to be risk factors for culture positive result. So, interventions for reducing community acquired pneumonia should be integrated with lifestyle factors related to household and alcohol use. Key word: Adult, Antimicrobial susceptibility profile, Bacterial isolates, Community Acquired Pneumonia, Felege Hiwot Referral Hospital