Objective To analyze the isolation and antimicrobial resistance of imipenem-resistant Pseudomonas aeruginosa (IRPA), and provide support for the prevention and control of IRPA infection. Methods Detection rate, department source, specimen source, antimicrobial resistance rate of IRPA and defined daily doses (DDDs) of commonly used antimicrobial agents in Inner Mongolia Autonomous Region People's Hospital from January 2017 to December 2021 were analyzed retrospectively. Relationship between DDDs value of commonly used antimicrobial agents and antimicrobial resistance of Pseudomonas aeruginosa (PA) was analyzed. Results From 2017 to 2021, 1 114 IRPA strains were detected from 4 170 PA strains, with a detection rate of 26.71%. The detection rates of each year were 31.09%, 30.05%, 27.64%, 26.66% and 23.18% respectively, showing a downward trend(χ²=17.347, P < 0.001). IRPA strains were mainly from cadre health care ward, intensive care unit (ICU) and respiratory department, accounting for 54.76%, 11.85% and 8.26%, respectively. The department with the highest IRPA detection rate was ICU (44.30%). IRPA was mainly isolated from sputum, urine and bronchoalveolar lavage fluid, accounting for 80.61%, 5.92% and 5.39%, respectively. Among the detected specimens, pharyngeal swab had the highest IRPA detection rate (54.17%). Resistance rates of IRPA to piperacillin, piperacillin/tazobactam, ceftazidime, amikacin, gentamicin, tobramycin, levofloxacin, meropenem and ciprofloxacin increased first, then decrease. Except meropenem, there was statistically significant difference in the change of antimicrobial resistance rate of other detected antimicrobial agents (all P < 0.05). From 2017 to 2021, IRPA had lower resistance rates to amikacin, gentamicin and tobramycin, and had higher resistance to the other 7 antimicrobial agents, especially to meropenem (above 80%). Total DDDs have been decreasing year by year since 2018. Within 5 years, the DDDs of ceftazidime, levofloxacin and gentamicin ranked among the top 3 commonly used antimicrobial agents in this hospital. There was no linear correlation between IRPA resistance rate and the DDDs of commonly used antimicrobial agents (P>0.05). Conclusion IRPA is mainly distributed in cadre health care ward, and sputum is the main specimen source. There was no linear correlation between IRPA resistance and the DDDs of commonly used antimicrobial agents within 5 years. Although antimicrobial resistance of IRPA has been controlled to a certain extent, it is still serious. Hospitals should strengthen various infection prevention and control measures to effectively control antimicrobial resistance and infection of IRPA.