There are limited data on pulmonary tuberculosis (PTB) requiring intensive care unit (ICU) admission despite its high mortality rate. The objectives of our study were to determine the prevalence of culture-confirmed PTB requiring ICU admission and the trend in prevalence before and during the COVID-19 pandemic. A retrospective cohort study was conducted on all patients aged ≥18 years with culture-confirmed PTB requiring ICU admission in a Malaysian tertiary academic medical center from 2015 to 2021. The linear-by-linear association test was performed to determine if the trend in prevalence was significant. The overall prevalence of culture-confirmed PTB requiring ICU admission was 8.0% (139/1736). Between 2015 and 2021, the prevalence increased by 5.8% from 1.6% (5/312) to 7.4% (16/215) (P < .001). This study demonstrated an overall low but increasing trend in the prevalence of culture-confirmed PTB requiring ICU admission. Disruption in TB services during the COVID-19 pandemic may have impacted the prevalence trend.