Tehran University of Medical Sciences Journal of Medical Bacteriology 2251-8649 13 2 2025 05 06 54 62 Mahdi Bozorgi Department of Infectious Diseases, Kashan School of Medicine, Kashan University of Medical Sciences Kashan Iran. Mohammad Javad Azadchehr Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran. Saina Najafi Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Najmeh Sedighimehr Department of Physiotherapy, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Javad Fathi Department of Bacteriology and Virology, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Hamed Pahlevani Department of Anesthesiology, Kashan School of Medicine Kashan University of Medical Sciences Kashan Iran. Maedeh Najafizadeh Department of Infectious Diseases, Kashan School of Medicine, Kashan University of Medical Sciences Kashan Iran. 2025 01 31 2025 02 06 Background:   COVID 19 pandemic has resulted in increased ICU admission, with many patients requiring mechanical ventilation resulting in more incidences of ventilator associated pneumonia (VAP). Despite vast research on COVID 19 complications, very few studies have looked at the risk factors of VAP in this population. The purpose of this study is to bridge this gap by identifying clinical and laboratory predictors of VAP in critically ill COVID-19 patients. Methods:   Shahid Beheshti Hospital, Kashan was the site of a retrospective analysis of 235 COVID 19 ICU patients requiring mechanical ventilation. Therapeutic interventions were assessed and clinical symptoms, laboratory markers were assessed. Results:   Fever and chills were also found to be associated with nearly a threefold increase in risk (p < 0.05) as was abnormal heart rate, which increased the risk fourfold (p < 0.001), and WBC and ESR significantly correlated with VAP occurrence. In addition, patients not treated with tocilizumab had a sixfold increase in risk of VAP (p < 0.001). Early identification and targeted interventions to mitigate the risk of VAP in COVID-19 patients being mechanically ventilated is a focus of this study. Conclusion:   Results indicate immunomodulatory therapy may provide a protective role, and underscore the importance of strict infection control. Future research should model causal mechanisms and develop best treatment strategies to reduce the incidence of VAP. https://jmb.tums.ac.ir/index.php/jmb/article/view/561