Objective To analyze the distribution and drug resistance of pathogenic bacteria in respiratory tract of the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in order to guide rational clinical drug use. MethodsThe clinical data of 93 elderly AECOPD patients who had positive sputum culture results admitted in the Department of Emergency Critical Care Medicine of the Affiliated Hospital of Xuzhou Medical University from December 2014 to June 2019 were collected and retrospectively analyzed. The sputum samples of the patients were tested for pathogenic bacteria and drug susceptibility test to study the distribution and drug resistance of pathogenic bacteria. Results Among the elderly AECOPD patients with positive sputum culture results, there were 55 cases (59.14%) of single infection, including 50 cases (53.76%) of bacterial infection and 5 cases (5.38%) of fungal infection; and 38 cases (40.86%) of mixed infection, including 24 cases (25.81%) of mixed infection of multiple bacteria and 14 cases (15.05%) of bacterial and fungal mixed infection. In the 138 detected pathogens, there were 15 strains of Gram-positive bacteria (10.87%), 103 strains of Gram-negative bacteria (74.64%) and 20 strains of fungi (14.49%). Gram-positive bacteria were mainly Staphylococcus aureus. Gram-negative bacteria were mainly Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, etc. And fungi were mainly Candida albicans, Aspergillus, etc. The drug resistance rates of Staphylococcus aureus in Gram-positive bacteria to penicillin, oxacillin, clindamycin and erythromycin were all 100%, and those to teicoplanin, vancomycin, daptomycin, linezolid, quinupristin and nitrofurantoin were 0%. The drug resistance rates of Gram-negative bacteria to cefazolin and ceftriaxone were all 100%, those to ceftazidime, levofloxacin, ciprofloxacin and cotrimoxazole were larger than 40%, and the sensitivity to tigacycline and polymyxin was higher. Conclusion Respiratory pathogens in the elderly AECOPD patients are mainly Gram-negative bacteria, with Acinetobacter baumannii the most common. There are many drug-resistant bacteria in the detected pathogenic bacteria, so antimicrobial drugs should be reasonably selected according to the results of bacterial culture and drug resistance analysis.