Objective To analyze the risk factors for early lower respiratory tract infection (LTRI) after lung transplantation and to summarize the common pathogens and drug resistance. Methods A retrospective study is made of data of the patients transferred to the intensive care unit (ICU) of China-Japan Friendship Hospital after lung transplantation from August 2021 to April 2022. The patients were divided into LTRI (n=40) and control groups (n=20) according to the development of LRTI within 1 week after lung transplantation. Binary logistic regression was used to analyze risk factors for LTRI . Common pathogens and the patients with drug resistance of the early LTRI after the lung transplantation were counted. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t-test, Mann-Whitney U test, χ²test or Fisher test, depending on data type.Results LRTI occurred in 67% (40/60) of the lung transplant recipients in the early post-transplant period, and the duration (d) of using restricted antibiotics was longer in the LRTI group than in the control group (P<0.05). Low body mass index (BMI) (OR= 0.838,95%CI 0.710-0.989), presence of multiple bacteria in the postoperative lungs (OR= 5.100,95%CI 1.267-20.528), connective tissue disease (OR= 15.016,95%CI 1.364-165.276), and low serum albumin (OR=0.878,95%CI 0.783-0.984) were independent risk factors for LRTI within 7 d after lung transplantation (P<0.05). The pathogens were predominantly bacteria (89.34%, 109/122). Acinetobacter baumannii [16(13.11%)], Pseudomonas aeruginosa [17(13.93%)] and Klebsiella pneumoniae [17(13.93%)] were the most common gram-negative bacteria. Testing for drug susceptibility showed resistance in 54.55% (12/22) of Pseudomonas aeruginosa, 60.87% (14/23) in Klebsiella pneumoniae, and 84.21% (16/19) in Acinetobacter baumannii. Conclusion Improving patients′ malnutrition and enhancing screening lung donors are conducive to early detection and prevention of LRTI. Pathogens causing early lung infections after the lung transplantation are predominantly bacteria with a high rate of drug resistance, and clinicians should pay special attention to rational anti-infective treatment regimen.