For a study, researchers sought to identify the risk markers of multi-drug resistant bacteria (MDRB)-related ventilator-associated pneumonia (VAP) in septic shock patients with a history of MDRB carriage. From 2010 to 2020, the retrospective study was conducted in a medical ICU. Patients with septic shock who remained in the ICU for at least 48 hours were eligible. Stenotrophomonas maltophilia, an extended-spectrum beta-lactamase-producing Enterobacteriaceae, a methicillin-resistant Staphylococcus aureus, a multi-drug resistant Pseudomonas aeruginosa, an imipenem-resistant Acinetobacter baumanii, and Stenotrophomonas maltophilia were the MDRB. At the time of ICU admission and throughout the patient’s stay in the ICU, MDRB colonization was checked for. Using a time-dependent, cause-specific Cox model, the MDRB-related VAP risk factors were evaluated. About 122 (18.9%) of the 643 individuals studied experienced at least 1 episode of VAP. The overall ICU mortality rate was 32.5%. The prevalence of MDRB carriage was 31%, composed of MDRB carriage at admission (14.3%) and MDRB acquired during ICU stay (16.7%). In multivariate analysis, colonization of MDRB in the ICU was independently associated with an increased risk of VAP (CSH: 1.85; 95% CI: 1.05–3.23; P=0.03), whereas carriage before admission was not. Carriage of imported and acquired MDRB was associated with different risks of eventual MDRB-related ventilator-associated pneumonia in patients experiencing a septic shock.