Objective. To study the etiological structure and antimicrobial resistance of hospital-acquired pneumonia pathogens in patients with complicated cervical spine injury. Materials and methods. A retrospective study included 418 bacterial isolates from sputum in 29 patients with hospital-acquired pneumonia who were treated in ICU during the period 2012-2013 and 2017-2018. Results. The most common pathogens from the lower respiratory tract, both in 2012-2013 and in 2017-2018 were Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae. The share of K. pneumoniae in 2017-2018 increased by 16.8 % (3.2 times more often), and the share of microorganisms of the Enterobacteriaceae - by 26.7 % (p < 0.001). The dynamic's analysis shows an increase in the resistance of hospital gram-negative pathogens of hospital-acquired pneumonia to the main antimicrobial classes and an increase of the frequency of extremely resistant pathogens in 2017-2018 P. aeruginosa by 19.9 % (p = 0.008), A. baumannii by 13.8 % (p = 0.189), K. pneumoniae by 66.7 % (p < 0.001). Conclusion. Gram-negative microorganisms are the leading pathogens of hospital-acquired pneumonia in patients with complicated cervical spine injury. An increase of the level of antibiotic resistance creates an unfavorable background regarding the effectiveness of antimicrobial therapy for hospital-acquired pneumonia in patients with a complicated cervical spine injury.