Objective To understand the distribution and antimicrobial resistance of frequently isolated pathogenic bacteria from hospitalized patients in nephrology department in China. Methods All isolated pathogenic bacteria from hospitalized patients in nephrology department reported by member units of China Antimicrobial Resistance Surveillance System (CARSS) in 2021 and their antimicrobial resistance were analyzed. Results A total of 122 203 bacterial strains were isolated from hospitalized patients in nephrology department, mainly from urine, sputum and blood, accounting for 49.2%, 16.7% and 13.4%, respectively. 81 994 strains (67.1%) were Gram-negative bacteria and 40 209 strains (32.9%) were Gram-positive bacteria. The top 5 frequently isolated pathogens were Escherichia coli (39 914, 32.7%), Klebsiella pneumoniae (12 695, 10.4%), Staphylococcus aureus (11 977, 9.8%), Pseudomonas aeruginosa (6 583, 5.4%) and Enterococcus faecium (5 821, 4.8%). The detection rate of ceftria-xone-resistant Escherichia coli and Klebsiella pneumoniae were 47.2% (15 704/33 272) and 30.7% (3 091/10 070), respectively. The detection rates of carbapenem-resistant Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae were 1.0% (388/38 813), 8.2% (1 000/12 206) and 4.8% (135/2 813), respectively. The resistance rates of Acinetobacter baumannii to imipenem, meropenem, polymyxin and tigecycline were 27.6% (972/3 523), 29.6% (813/2 748), 1.3% (8/625) and 2.2% (38/1 730), respectively. The resistance rates of Pseudomonas aeruginosa to imipenem, meropenem and polymyxin were 10.1% (640/6 335), 8.4% (477/5 678) and 1.2% (11/955), respectively. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcs (MRCNS) were 23.3% (2 787/11 977) and 68.5% (7 290/10 644), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 1.1% (65/5 740) and 0.1% (7/4 738), respectively. Conclusion Gram-negative bacteria isolated from hospitalized patients in nephrology department are mainly Escherichia coli and Klebsiella pneumoniae, and Gram-positive bacteria are mainly Staphylococcus aureus. The resistance rates of Gram-ne-gative bacteria to carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam, and ceftazidime/avibactam are low, and the resistance rates of Gram-positive bacteria to vancomycin, teicoplanin, and linezolid are low. Antimicrobial agents should be selected rationally according to antimicrobial susceptibility testing results and disease features of patients in nephrology department.