Abstract: OBJECTIVE To explore the epidemiological characteristics and risk factors for health care-associated infections (HAIs) in elderly hospitalized patients of neurosurgery department. METHODS The clinical data were retrospectively collected from the elderly patients of neurosurgery department who were no less than 65 years of age between 2023 and 2024, the patients who had HAIs were chosen as the core research subjects. The distribution, influencing factors and etiological characteristics of HAIs were systematically analyzed. RESULTS A total of 629 patients were enrolled in the study, 114 of whom had HAIs, with the infection rate 18.12%. Among the patients with HAIs, the patients with respiratory system infections accounted for 60.53%, and the patients with urinary system infections accounted for 29.82%. The risk of HAIs in the elderly patients with neurosurgery department was closely associated with the age, times of surgery, type of surgery, length of hospital stay more than 14 days, time of postoperative drug administration, use of ventilator, urinary catheter indwelling, and underlying diseases(P＜0.05). Klebsiella pneumoniae (37 strains), Acinetobacter baumannii (18 strains) and Escherichia coli (13 strains) ranked the top 3 species of isolated pathogens. The result of antimicrobial testing showed that the drug resistance rate of the K. pneumoniae strains to antibiotics such as piperacillin-tazobactam, imipenem and ertapenem were low, and the E. coli strains were mainly resistant to penicillins and sensitive to carbapenems. CONCLUSIONS It is an effective way to strengthen the treatment of underlying diseases in the elderly patients of neurosurgery department and shorten the length of hospital stay so as to reduce the incidence of HAIs. Antimicrobial therapy should be optimized according to susceptibility results in clinical practice.