Objective To analyze the distribution and drug resistance of pathogenic bacteria in 171 children with septic arthritis，and to provide a basis for clinical diagnosis and treatment. Methods Based on bacterial culture and drug sensitivity test results，we analyzed the distribution and drug resistance of pathogenic bacteria in patients with septic arthritis in Children’s Hospital of Chongqing Medical University from January 2012 to December 2022. Results A total of 82 strains of pathogenic bacteria were detected in 171 patients，including 74 Gram-positive （G⁺） and 8 Gram-negative strains（G^-）. The top three bacteria were Staphylococcus aureus（54 strains，65.9%），Streptococcus pyogenes（7 strains，8.5%），and Streptococcus pneumoniae（5 strains，6.1%）. The predominant pathogens were Staphylococcus aureus and Streptococcus pneumoniae in patients under two years of age （15 cases，71.4%），Staphylococcus aureus in patients between two and five years of age（9 cases，81.8%），and Staphylococcus aureus and Streptococcus pyogenes in patients over five years of age（40 cases，88.9%）. For all G⁺ bacteria，the rates of resistance to vancomycin and linezolid were 0%. The resistance rates of Staphylococcus aureus to benzoxacillin，amoxicillin/clavulanic acid，cefaclor，and flucloxacillin were <30%. The resistance rate of Streptococcus pyogenes to penicillin was 0%. Streptococcus pneumoniae was 20% resistant to penicillin and ceftriaxone. All G^- bacteria were 0% resistant to ceftazidime，cefepime，levofloxacin，ciprofloxacin，and imipenem. Conclusion Clinicians should choose appropriate antimicrobial drugs to treat septic arthritis according to the main pathogens and their resistance characteristics in local regions as well as the age distribution of patients.