Objective To analyze risk factors and pathogen distribution of hospital-acquired pneumonia (HAP) in patients with tetanus, and provide reference for clinicians to prevent and control HAP in such patients. Methods Clinical data of patients with tetanus who were admitted to the department of infectious diseases of Affiliated Hospital of Southwest Medical University from January 2014 to June 2019 were collected, patients were divided into two groups according to whether they had developed HAP, distribution of pathogens was analyzed, and risk factors for HAP in patients with tetanus were statistically analyzed. Results Of 75 patients with tetanus, 44 (58.7%) had HAP, 11 death patients all developed HAP. Univariate analysis on risk factors for HAP in patients with tetanus showed that the proportion of age ≥ 60 years, long-term smoking, chronic lung disease, Ablett grade ≥ Ⅲ and tracheo- tomy in patients in HAP group were all higher than those in non-HAP group (all P<0.05); logistic regression analysis showed long-term smoking(OR=7.00, 95% CI:1.17-41.91), chronic lung disease(OR=9.84,95% CI:1.37-70.52), Ablett grade ≥ Ⅲ (OR=24.53, 95% CI:3.81-157.76) were independent risk factors for HAP in patients with tetanus. 24 strains of pathogens were isolated from 44 patients, pathogens were mainly Gram-negative bacteria such as Pseudomonas aeruginosa (n=8 strains) and Klebsiella pneumoniae (n=7 strains). Conclusion Incidence of HAP in patients with tetanus is high, pathogens are mainly Gram-negative bacteria. Tetanus patients with long-term smoking, chronic lung disease and Ablett grade ≥ Ⅲ are easily to develop HAP.