Objective To analyze the trends and antimicrobial resistance of carbapenem-resistant Enterobacterales (CRE), and guide the rational use of antimicrobial agents in clinical practice. Methods WHONET 5.6 software was used to analyze the isolation rate, specimen source, ward distribution, and antimicrobial resistance of CRE in patients admitted to a hospital from January 2013 to December 2022. Results From 2013 to 2022, a total of 32 320 strains of pathogenic bacteria were detected from patient specimens collected at this hospital, among which 1 347 were CRE strains (4.17%). The top 3 detected CRE were carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CREC), and carbapenem-resistant Enterobacter cloacae (CRECL), accoun-ting for 78.10% (n=1 052), 7.94% (n=107), and 7.80% (n=105), respectively, the detection rates were 12.37% (1 052/8 504), 0.58% (107/18 407), and 5.36% (105/1 960), respectively. The detection rates of CRE, CRKP, CREC, and CRECL in 2022 were all higher than those in 2013 (all P < 0.05), and the detection rates in 2018 were higher than in 2017 (P < 0.05). The detection rates of CRE and CRKP showed an upward trend in other time periods, but the trend remained stable. The detection rate of CRECL started to decline since 2020, with a significant decrease in 2021 compared to 2020 (P < 0.05). While in other time periods, the CRECL detection rate has shown an upward trend with a stable pattern. The main source of specimens of CRKP and CRECL was respiratory tract, followed by urine and blood. The main source of CREC specimens was urine, followed by respiratory tract and blood. The main wards sources of CRE were cadre health care wards, intensive care unit, and department of neurosurgery. The resistance rates of CRKP, CREC, and CRECL to tigecycline were all 0. Comparison in the resistance rates of CRKP, CREC, and CRECL to aminoglycosides (amikacin, tobramycin, and gentamicin) showed that resistance rates of CRECL were the lowest (3.81%, 15.31%, 32.65%, respectively), followed by CREC (34.58%, 61.96%, 65.22%, respectively), and CRKP was the highest (84.22%, 87.06%, 88.16%, respectively). The resistance rates of CRECL to ciprofloxacin and levofloxacin (82.86%-89.80%) were lower than those of CRKP (97.72%-98.35%) and CREC (94.39%-97.83%). The resistance rates of CRKP, CREC, and CRECL to meropenem were 98.10%, 83.65%, and 82.52%, respectively. Conclusion The detection rate of CRE shows an increasing trend, and antimicrobial resistance is severe. Clinicians should choose antimicrobial agents rationally based on antimicrobial susceptibility test and take effective measures to reduce the infection rate of CRE.