Objective To investigate distribution and characteristics of antibiotic resistance of sputum pathogens for stroke-associated pneumonia (SAP) in emergency intensive care unit (EICU).  Methods Pathogenic bacteria were isolated from sputum specimens of SAP patients in EICU of our hospital. Then, the distribution and the drug resistance of the pathogenic bacteria were investigated.  Results Out of the 235 SAP patients, there were 132 patients that sputum culture results were positive, the culture-positive rate was 56.2%. A total of 232 isolates were available from these patients. Of all the isolates, 156 strains were Gram negative bacteria (67.2%), 31 strains were Gram positive bacteria (13.4%); 40 strains were Gram positive bacteria (17.2%); and 5 strains were fungi (2.2%). The top four Gram negative bacteria were as follows: Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Escherichia coli. The ratio of the extended spectrum β-lactamases (ESBLs) producing strains in Klebsiella pneumoniae and Escherichia coli is high. Both Pseudomonas aeruginosa and Acinetobacter baumannii had high resistant rates against antibiotics, and they were characterized by multiple drug resistance. The Gram positive bacteria mainly were Staphylococcus aureus and Enterococcus. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 62.5%, and they were all sensitive to vancomycin, linezolid or teicoplanin. While Enterococcus had high resistant rates against penicillin, quinolones and macrolide antibiotics, they had low resistant rates against vancomycin, linezolid or teicoplanin. Anaerobic bacteria included Bacteroides fragilis, Peptostreptococcus and Black-pigmented bacteria, and the cases mainly were mixed polymicrobial infections. Conclusion In EICU, Gram-negative bacteria are the predominant pathogens of SAP. Anaerobic bacteria and mixed polymicrobial infections are common in these patients, and there is a serious situation of antibiotic resistance. Studying on distribution and antibiotic resistance of pathogens might contribute to achieve rational prevention and tailored antibiotic treatment for SAP.