Objective To analyze pathogens detected in blood culture of elderly inpatients in a hospital and antimicrobial resistance of main pathogens. Methods Clinical data, pathogenic distribution and antimicrobial susceptibility testing results of elderly inpatients aged ≥60 whose specimens were performed blood culture in a hospital from Ja-nuary 2018 to December 2021 were retrospectively analyzed. Results A total of 8 138 blood culture specimens were detected, out of which 1 067 were positive, with blood culture positive rate of 13.11%. A total of 1 097 pathogenic strains were detected, including 837 Gram-negative bacterial strains, accounting for 76.30%. The top three detected pathogens were Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus, accounting for 41.84%, 15.41% and 3.83%, respectively. The most detected pathogens in blood culture were from intensive care unit (214, 19.51%). Resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin/tazobactam, ce-foperazone/sulbactam, carbapenems, amikacin and tegacyclin were 3.80% and 8.59%, 4.24% and 7.32%, < 1% and < 6%, 2.46% and 4.27%, 0 and 1.85%, respectively. Detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 21.95%. Minocycline-, vancomycin-, teicoplanin-, and linezolid-resistant Staphylococcus aureus were not detected. Conclusion The positive rate of blood culture from elderly patients is high. Major pathogens are Gram-negative bacteria, most of which are Escherichia coli and Klebsiella pneumoniae. Antimicrobial resistance varies in different pathogens. Blood culture should be performed in time to rationally use antimicrobial agents according to antimicrobial susceptibility testing results.