Objective To understand the distribution and antimicrobial resistance changes of pathogens from blood culture of children in 74 hospitals of monitoring network of antimicrobial resistance of pathogen in Hebei Province from 2016 to 2019. Methods WHONET software was used to retrospectively analyze the distribution and antimicrobial susceptibility characteristics of pathogens from blood culture of children in 45 tertiary hospitals and 29 se-condary hospitals. Results After eliminating repeated strains, a total of 7 591 strains were isolated from blood culture of hospitalized children from 2016 to 2019, Gram-positive bacteria and Gram-negative bacteria accounting for 71.7% and 28.3% respectively. In the four age groups defined in this study, the proportion of Staphylococcus aureus and Stenotrophomonas maltophilia increased with age. Resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 7.8%-35.5%. In the past 4 years, isolation rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) showed an upward trend (from 12.9% to 30.1%), isolation rate of methicillin-resistant coagulase negative staphylococcus (MRCNS) showed a downward trend (from 81.7% to 75.2%). Conclusion Gram-positive bacteria are the main pathogens of blood culture of hospitalized children in Hebei Province, distribution of pathogens is different from that of adult blood culture. Distribution of pathogens varied with age, attention should be paid to the characteristics of blood culture of children in clinical empirical treatment of blood stream infection in children.