〔Abstract〕 Objective To analyze the pathogen distribution and drug resistance of lower respiratory tract infection patients in Xinxiang First People's Hospital. Methods The clinical data of 3500 patients with lower respiratory tract infections in Xinxiang First People's Hospital from January 2018 to December 2022 were collected retrospectively. The distribution of pathogens and the resistance rate of pathogens to common antibiotics were analyzed. Results A total of 639 pathogenic bacteria were isolated from 3500 sputum samples, of which 429 were Gram-negative bacteria, accounting for 67.14 %; 155 Gram-negative bacteria, accounting for 24.26 %; 55 fungi, accounting for 8.61 %. Among the Gram-negative bacteria detected, the highest proportion was pseudomonas aeruginosa, accounting for 22.22 %, followed by Klebsiella pneumoniae, accounting for 17.53 %; Among the Gram-negative bacteria detected, the highest proportion was streptococcus pneumoniae, accounting for 11.42 %, followed by staphylococcus aureus, accounting for 9.55 %; Among the detected fungi, the highest proportion was candida albicans, accounting for 6.26 %, followed by candida tropicalis, accounting for 2.35 %. According to the analysis of drug resistance, the resistance rate of pseudomonas aeruginosa to ampicillin, cefazolin and ceftriaxone was higher in the main Gram-negative bacteria. The resistance rates of Klebsiella pneumoniae to ampicillin, ceftriaxone, cefoxitin and cefotaxime were high. The resistance rates of acinetobacter baumannii to ceftriaxone, cefotaxime, cefazolin and cefoxitin were high. The resistance rates of streptococcus pneumoniae to ampicillin, erythromycin, amoxicillin, clavulanic acid and tetracycline were higher in the main Gram-negative bacteria. Staphylococcus aureus had higher resistance rates to ampicillin, amoxicillin clavulanic acid and penicillin. Conclusion The lower respiratory tract infection in Xinxiang First People's Hospital is mainly caused by infection with Gram-negative bacteria, and the drug resistance rate of the main pathogens is high, and the drug resistance rate to various drugs is different. The clinical use of antibiotics should be reasonable according to the pathogen resistance.