〔Abstract〕 Objective To analyze the distribution and drug resistance of pathogenic bacteria in elderly patients with ventilatorsassociated pneumonia (VAP) in the intensive care unit of Zhoukou Hospital of Traditional Chinese Medicine. Methods A total of 86 elderly VAP patients admitted to the Intensive care Unit of Zhoukou Hospital of Traditional Chinese Medicine from February 2020 to February 2023 were selected as research objects. Secretion samples of lower respiratory tract of patients were collected for pathogen detection and drug sensitivity test, and the distribution of pathogenic bacteria and drug sensitivity were analyzed. Results In this study, a total of 119 strains of pathogenic bacteria were isolated and cultured in sputum culture of 86 elderly VAP patients, including 21 strains of fungi, accounting for 17.65%. There were 17 strains of gram-positive bacteria, accounting for 14.29%. Gram-negative bacteria accounted for 81 strains, accounting for 68.07%. The resistance of gram-negative bacteria to ceftriaxone, levofloxacin, meropenem and cefazolin was high, while the resistance to tobramycin, amicacin and imipenem was low. The resistance of gram-positive bacteria to cotrimoxazole, gentamicin, ciprofloxacin, erythromycin and penicillin was high, and the resistance to levofloxacin, cefoxitin and vancomycin was low. Conclusion The main pathogenic bacteria of elderly VAP patients in the intensive care unit of Zhoukou Hospital of Traditional Chinese Medicine are Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii, etc. In clinical treatment, targeted drugs should be given according to the distribution characteristics of pathogenic bacteria and drug tolerance.