Abstract: Objectives To explore the pathogen characteristic and drug sensitivity of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in neonates. Methods Clinical data of hospitalized neonates with pneumonia and positive sputum culture were retrospectively analyzed from January 2010 to December 2014. Results A total of 4383 strains of pathogenic microorganisms were detected from 3564 cases of neonatal with CAP, including 3584 strains of bacteria, 771 strains of virus, 7 strains of fungus, and 21 strains of atypical pathogen. Gram negative bacteria (3045 strains, 85%) were the dominant bacteria. The top three bacteria were Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Respiratory syncytial virus (693 strains, 89.9%) was the dominant virus. A total of 424 strains of pathogenic microorganisms were detected from 344 cases of neonatal with HAP, including 402 strains of bacteria, 17 strains of fungus, and 5 strains of respiratory syncytial virus. Bacteria were all gram-negative bacterium and no gram-positive bacterium was found. The top three bacteria were Klebsiella pneumonia, Escherichia coli, and Acinetobacter baumannii. The positive rates of ESBLs in Gram-negative bacteria were 26.9% in neonates with CAP and 46.8% in neonates with HAP respectively, and the difference was statistically significant (P < 0.05). Klebsiella pneumoniae and Escherichia coli in both CAP and HAP were highly sensitive to amikacin and carbopenems. The sensitivity of Klebsiella pneumoniae to common used antibacterial agents (except for amikacin and quinolones) in HAP was generally lower than CAP (P < 0.05). The sensitivity of Escherichia coli to common used antibacterial agents (except for amikacin, quinolones and carbapenems) in HAP was generally lower than CAP (P < 0.05). Moreover, carbapenem-resistant Enterobacteriaceae was found. Conclusions Gram-negative bacterium is the dominant pathogen in neonatal pneumonia. Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus are dominant pathogens in CAP. Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii are dominant pathogens in HAP. The enzyme-producing rate and drug resistance rate of pathogenic bacterium in HAP are generally higher than those in CAP, and there is a tendency of becoming multi-drug resistance.