A retrospective study analyzed microorganisms from tracheal aspirate cultures from 2018 to 2022 to determine their distribution, antibiotic susceptibility, and resistance trends in the ICU and wards. Of the causative isolates, 83.8% were gram-negative, while the most frequent pathogens were Klebsiella spp., Acinetobacter spp. and Pseudomonas spp. In Klebsiella spp. resistance to cephalosporins and fluoroquinolones was above 90%, to meropenem above 80%, while imipenem had a higher sensitivity. Acinetobacter spp. showed high resistance to most antibiotics, the lowest to amikacin. In Pseudomonas spp. resistance ranged from 40% to 55%, with amikacin being the most active. Resistance was higher in isolates from ICUs versus wards, and the analysis identified a tipping point around 2020 with heterogeneous trends. The study recommends locally tailored empiric therapy with Gram-negative coverage, early de-escalation, and annual surveillance of resistance, especially in the ICU.