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Background and objectives Lower respiratory tract infections (LRTIs) are a major cause of morbidity and mortality worldwide, with growing diagnostic challenges due to evolving bacterial profiles and antimicrobial resistance. This study aimed to evaluate the clinico-microbiological spectrum of bacteria isolated from bronchoalveolar lavage (BAL) samples in patients with suspected LRTIs and to analyze their antimicrobial susceptibility patterns at a tertiary care hospital in Odisha, India. Methods A retrospective observational study was carried out over three years, during which BAL samples from adult hospitalized patients with clinically diagnosed LRTIs were processed using established microbiological techniques. Bacterial identification and antimicrobial susceptibility testing were performed following standard microbiological procedures. Demographic data and comorbidities were also evaluated. Results Of 390 BAL samples, 222 (56.9%) yielded significant pathogenic growth. A male predominance and a high prevalence of comorbidities, particularly diabetes mellitus, were noted among the patients. Gram-negative bacteria constituted the majority of isolates, with Klebsiella pneumoniae as the most frequently isolated pathogen. Gram-negative isolates showed a high rate of resistance to β-lactams, cephalosporins, and fluoroquinolones, while Gram-positive cocci remained uniformly susceptible to vancomycin and linezolid. Conclusions The study highlights a predominance of Gram-negative pathogens in LRTIs and confirms BAL as an effective diagnostic modality. Continuous regional surveillance and prospective multicentric studies incorporating molecular resistance profiling are essential to guide rational empirical therapy and strengthen antimicrobial stewardship.