Objective To investigate the distribution and antimicrobial resistance of bacteria isolated from fecal specimens in China. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) technical scheme, data of bacteria isolated from fecal specimens and antimicrobial susceptibility testing results reported by CARSS member hospitals in 2020-2024 were analyzed using WHONET 5.6 software. Results A total of 118 539 bacterial strains were isolated, and the top 5 were Salmonella spp. (91.3%-93.9%), Shigella spp. (2.1%-4.7%), Aeromonas spp. (1.6%-2.0%), Vibrio spp. (0.9%-1.9%) and diarrheagenic Escherichia coli (0.4%-1.1%). The major bacteria in each genus were unclassified species of Salmonella (50.7%-55.6%), Shigella flexneri (41.8%-58.4%), Aeromonas hydrophila (32.0%-58.6%), Vibrio parahaemolyticus (73.4%-86.6%), and enteropathogenic Escherichia coli (72.0%-91.5%), respectively. Resistance rates of Salmonella spp. to levofloxacin (7.5%-10.9%)and ciprofloxacin (9.8%-11.6%) were low, while resistance rates of Shigella spp. to levofloxacin and ciprofloxacin presented upward trends, which increased from 18.6% and 33.5% to 63.0% and 71.0%, respectively. Resistance rates of Vibrio spp. to ampicillin (58.8%-68.9%) and cefazolin (88.9%-100%) were high, and that to cefuroxime has decreased (from 20.6% to 7.4%), while resistance rates to other antimicrobial agents were all low (<10%). The overall resistance of Aeromonas spp. was low. Carbapenem-resistant diarrheagenic Escherichia coli was detected (<3%). Conclusion The major bacteria isolated from fecal specimens were Salmonella spp. and Shigella spp.. Antimicrobial resistances of different bacterial species varied significantly. It is necessary to continue to strengthen the management of rational application of antimicrobial agents, and do a good job in the surveillance of antimicrobial-resistant bacteria.