Objective To understand the clinical characteristics of patients with Streptococcus anginosus group (SAG) pulmonary abscess and resistance of SAG. Methods 67 patients with pulmonary abscess admitted to a hospital from January 2018 to May 2022 were retrospectively analyzed, clinical data of patients with SAG pulmonary abscess were analyzed, and the minimum inhibitory concentration of antimicrobial agents to 18 SAG strains was detected by microbroth dilution method, the carriage of resistance genes and virulence genes of SAG were detected by high-throughput sequencing technology. Results Among 67 patients with pulmonary abscess, SAG accounted for 29.9% (20/67), out of which 2 were excluded due to bacterial inactivation, and 18 patients were included for further studies. 18 patients with SAG pulmonary abscess were all community acquired, with an average age of (60.9±9.1) years. There were 13 (72.2%) male patients, most patients (94.4%) complicated chronic pulmonary disease, with cough (94.4%) and expectoration (88.9%) as the initial symptoms, some patients (44.4%) had chest pain, and more than half (61.1%) didn’t have fever. The proportion of neutrophils, erythrocyte sedimentation rate, and C-reactive protein were mostly elevated, while procalcitonin was normal. The resistance rate of 18 SAG strains to erythromycin, clindamycin, and tetracycline was >65%, out of which 14 strains carried resistance gene ermB, 13 strains carried resistance gene tetM, and 1 strain carried both resistance gene msrD and mefA. 18 SAG strains were detected virulence gene psaA, out of which 3 strains were detected virulence gene nanA. Conclusion SAG is an important pathogen that causes pulmonary abscess, and the patients’complications are mainly chronic pulmonary di-seases, with non-specific clinical manifestations; Most strains carry ermB and tetM genes, mediating resistance to macrolides, lincosamides, and tetracyclines.