Objective To investigate the effect of peri-operative blood glucose control level on surgical site infection (SSI) and pathogen distribution in patients with diabetes undergoing bone and joint replacient. Methods From May 2014 to May 2022, patients with type 2 diabetes undergoing bone and joint replacient in 7 hospitals were selected as studied subjects. According to peri-operative level of hioglobin A1c (HbAlc), patients were divided into good blood glucose control (GBGC) group and poor blood glucose control (PBGC) group. Incidence of SSI, wound healing time, length of hospital stay, total medical expense, distribution of infection pathogens and antimicrobial resistance were compared between two groups. Univariate and multivariate analyses were used to analyze the risk factors for PBGC. Results A total of 1 480 patients were recruited, including 768 in GBGC group and 712 in PBGC group. Incidence of SSI were 7.16% and 14.89% in GBGC group and PBGC group respectively. Wound healing time, length of hospital stay, infection course and total medical expense in GBGC group were all lower than PBGC group (all P < 0.01). Constituent rate of isolated Gram-positive (G⁺) bacteria in GBGC group was higher than that in PBGC group, while constituent rate of isolated Gram-negative (G^-) bacteria in GBGC group was lower than that in PBGC group (P < 0.05). The course of diabetes >10 years (OR=1.826, 95%CI [1.664-2.005]), pre-operative Hamilton Anxiety Scale (HAMA) >14 points (OR=3.301, 95%CI [1.756-6.215]), general anesthesia (OR=1.941, 95%CI [1.057-3.563]), and duration of operation >3 hours (OR=2.308, 95%CI [1.134-4.657]) were independent risk factors for PBGC during peri-operative period of bone and joint replacient (all P < 0.05). Conclusion The peri-operative blood glucose control of diabetes patients with bone and joint replacient has certain impact on SSI and pathogen distribution. Pre-operative anxiety state of patients, course of diabetes, mode of anesthesia and duration of surgery are independent risk factors for poor peri-operative blood glucose control.