OBJECTIVE： To explore the distribution and drug resistance of pathogens in patients with hospital-acquired pneumonia （HAP） from neurosurgery department of the First Affiliated Hospital of Xinjiang Medical University （called “our hospital” for short）， so as to provide reference for clinical use of antibiotics in the clinic. METHODS： The pathogen culture and drug sensitivity test of 652 HAP patients were analyzed retrospectively in neurosurgery department of our hospital during May 2011 to May 2015. RESULTS： Of 652 cases， pathogens were detected in 608 cases， with positive rate of 93.3％. Among 608 strains of pathogen， there were 443 strains of Gram-negative bacteria （71.2％） as Klebsiella pneumonia， Pseudomonas aeruginosa and Escherichia coli； 108 strains of Gram-positive bacteria （17.8％） as Staphylococcus aureus and Streptococcus pneumoniae； 67 strains of fungus （11.0％）as Candida albicans. There were 67 strains of ESBLs K. pneumonia， 43 strains of ESBLs E. coli and 8 strains of methicillin-resistant coagulase negative Staphylococci. The drugs sensitive to Gram-negative bacteria included imipenem， piperacillin sodium and tazobactam sodium， cefepime， etc.； those sensitive to Gram-positive bacteria included vancomycin， etc. CONCLUSIONS： Main pathogen of HAP patients in neurosurgery department of our hospital are Gram-negative bacteria， and they were highly resistant to antibiotics； the highly sensitive drugs to HAP include imipenem and vancomycin， etc.； the antibiotics should be used rationally according to etiological analysis.