Objective To investigate the distribution characteristics and antimicrobial resistance of pathogens isolated from pleural effusion specimens in China. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) technical program, data of bacteria isolated from pleural effusion specimens and antimicrobial susceptibility testing results reported by CARSS member hospitals in 2014-2019 were analyzed with WHONET 5.6 software. Results A total of 75 375 strains of bacteria were isolated from pleural effusion specimens in 2014-2019, Gram-positive bacteria were mainly Staphylococcus aureus; Gram-negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae. Isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) in 6 years were between 33.7%-43.4%. Resistance rates of MRSA to all antimicrobial agents were all significantly higher than those of methicillin-susceptible Staphylococcus aureus (MSSA). Vancomycin-, teicoplanin- and linezolid-resistant Staphylococcus aureus were not found; resistance rates of Streptococcus pneumoniae to penicillin were 1.1%-7.6%; most Enterobacteriales had good activity on carbapenems, resistance rates of Escherichia coli to the third generation cephalosporins showed a slightly downward trend. Conclusion Isolation rate and distribution of bacteria from pleural effusion in China changed little, proportion of Gram-positive bacteria and Gram-negative bacteria is similar. Resistance rates of some strains to partial antimicrobial agents decreased in varying degrees. Surveillance on Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae should be strengthened to guide clinical rational antimicrobial use.