ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing pneumonia in acute stroke patients, and guide clinical antimicrobial use.Methods Patients with strokeassociated pneumonia(SAP) admitted to a tertiary firstclass hospital from 2008 to 2013 were investigated retrospectively, distribution and antimicrobial susceptibility testing results of pathogens from sputum were analyzed.ResultsA total of 98 patients with SAP were investigated, 124 stains were isolated from sputum specimens, 75 strains (60.48%) were gramnegative bacteria, 44 (35.49%) were grampositive bacteria, and 5 (4.03%) were fungi. There were 21 cases of mixed infection (21.43%), bacterial alterations during treatment process existed among 23 cases（23.47%）.The top 4 isolated pathogens were Staphylococcus aureus（S. aureus,n=43，34.68%）, Klebsiella pneumoniae（K. pneumoniae, n=19，15.32%）, Pseudomonas aeruginosa（P. aeruginosa, n=18，14.52%）, and Acinetobacter baumannii（A. baumannii, n=18，14.52%）. Antimicrobial resistance rates of K. pneumoniae were all ＜32%，and susceptibility rates to ceftazidime, piperacillin /tazobactam, imipenem, ciprofloxacin, levofloxacin, amikacin, and tobramycin were all 100%. Both A.baumannii and P.aeruginosa showed severe multidrug resistance. Resistance rates of A.baumannii to ceftazidime was >80%, resistance rates of P.aeruginosa to imipenem was 33.33%. No resistant strains were detected among fungi.ConclusionThe main pathogens causing SAP in this hospital are S.aureus, K.pneumoniae, A.baumannii, and P.aeruginosa, except K.pneumoniae, the other strains are severely resistant to antimicrobial agents, clinicians should choose antimicrobial agents according to the distribution characteristics and antimicrobial susceptibility testing results.