Objective To understand the direct economic loss of lower respiratory tract (LRT) healthcare-associa-ted infection (HAI). Methods 50 patients with LRT HAI in a tertiary general hospital in Fuyang City from May 1, 2018 to May 31, 2020 were selected as case group, a 1:1 matching study was adopted, 50 inpatients who had no LRT HAI and no other sites HAI during the same period, had the same initial diagnosis at admission and discharge were in control group, direct economic loss caused by LRT HAI was compared. Results The median of total hospitalization expense and average daily hospitalization expense in case group were 64 858.5 Yuan and 2 128.6 Yuan respectively; in control group were 26 728.0 Yuan and 1 477.5 Yuan respectively. The direct economic loss caused by LRT HAI was 38 130.5 Yuan/case, mainly expense of medicine, other (material), diagnosis and treatment, and nursing, expense of medicine was the highest. Except for the operation expense, the other medical expenses in case group were all higher than those in control group, differences were all significant (all P < 0.05). Compared with control group, the main increased expenses in case group were antimicrobial agents, inflammatory indicators and imaging examination. Differences of median were 2 962.0, 180.0, 444.0 and 1 288.5 Yuan respectively, differences were all significant (all P < 0.01). Length of hospitalization stay in case group and control group were (29.3±15.2) days and (14.9±7.5) days respectively, there was significant difference between two groups (P < 0.001). Conclusion Direct economic loss caused by LRT HAI is serious, the total expense and daily average hospitalization expense increased, and length of hospital stay is prolonged, much attention should be paid, prevention and control measures should be taken as early as possible.