Introduction: Lower respiratory tract infection is a common cause of morbidity and mortality among individuals of all age groups in developing countries. It is caused by wide variety of infectious agents like viruses, bacteria, fungus and parasites. The role of drug resistant bacteria is of most important concern nowadays with fewer antibiotic options available. Methods: A prospective observational study was conducted in an apex referral hospital among patients of all age groups with symptoms of lower respiratory tract infection (LRTI) for a period of 6 months. The samples included respiratory specimens such as sputum, endotracheal (ET) aspirate and brochoalveolar lavage (BAL). The samples were investigated for bacterial agents by microscopy, culture and anti-microbial susceptibility testing was performed. Results: A total of 525 Gram-negative pathogens were isolated from sputum, ET aspirate and BAL fluid specimens during the study period. In 456/525(87%) cases the infection was mono-microbial in nature and in rest 13% cases the infection was polymicrobial type. The gram negative isolates showed high levels of antibiotic resistance to third generation cephalosporins such as ceftriaxone and ceftazidime which were around 92.1% and 78.9% resistant respectively. The resistance to carbapenems was also high. The maximum susceptibility shown by the isolates was for colistin and tigecycline. Mortality was seen in 13% patients with LRTI. Conclusion: Most of the gram negative isolates obtained from the LRTI samples showed high levels of drug resistance to common antibiotics and showed susceptibility to only high end antibiotics. The findings of the study emphasizes the urgent need for routine surveillance and formulation of antibiotic policies in the hospitals to reduce mortality and morbidity..