Abstract: OBJECTIVE To retrospectively analyze the distribution of pathogens causing hospital-acquired pneumonia（HAP） in the elderly hospitalized patients with chronic heart failure and observe the influencing factors so as to put forward effective measures for prevention and control of nosocomial infection. METHODS A total of 825 elderly patients with chronic heart failure who were hospitalized the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from May 2016 to May 2018 were recruited as the study objects.The incidence of HAP, distribution of pathogens and influencing factors were retrospectively analyzed. RESULTS Totally 204 patients had HAP, with the incidence rate 24.73%（204/825）.The pathogens were isolated from sputum specimens of 122 patients, with the isolation rate 59.80%.A total of 145 strains of pathogens were isolated, 92 of which were gram-negative bacteria, 40 were gram-positive bacteria, and 13 were fungi.Staphylococcus aureus strains were highly resistant to penicillin G, ampicillin, erythromycin and sulfamethoxazole-trimethoprim, while the drug resistance rates of the strains to cefoperazone-sulbactam, ceftazidime and tobramycin were low; the strains that were resistant to vancomycin or linezolid were not found.The major species of gram-negative bacteria were highly resistant to ampicillin, sulfamethoxazole-trimethoprim and piperacillin, while the drug resistance rates of the strains to imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam and amikacin were low.The result of multivariate logistic regression analysis showed that the incidence of HAP in the elderly patient with chronic heart failure was associated with the age, cardiac function, complication with diabetes mellitus, complication with COPD, invasive operation and intensive diet nursing（P＜0.05）. CONCLUSION The incidence of HAP in the elderly hospitalized patient with chronic heart failure is associated with the age, complications, cardiac function and treatment as well as nursing.The gram-negative bacteria such as Klebsiella pneumoniae are dominant among the pathogens causing the infection.It is necessary for clinicians to take effective preventive interventions and use antibiotics based on the result of drug susceptibility testing.