Background <p>This study aimed to analyze the clinical distribution and changes in drug resistance of <i>Pseudomonas aeruginosa</i> (PA) and carbapenem-resistant <i>Pseudomonas aeruginosa</i> (CRPA) at The Affiliated Suzhou Hospital of Nanjing Medical University from 2019 to 2024, providing evidence for hospital infection prevention and control, as well as the rational clinical use of antibiotics.</p> Methods <p>A six-year retrospective study was conducted. Non-duplicate PA strains isolated from clinical specimens in this hospital from January 1, 2019, to December 31, 2024, were included. Statistical analysis was performed on specimen sources, department distribution, patient epidemiological characteristics, and antimicrobial susceptibility test results.</p> Results <p>A total of 4,046 PA strains were detected, of which 1,340 were CRPA, resulting in an overall detection rate of 33.12%. The CRPA detection rate showed minor fluctuations from 2019 to 2023, with a peak of 37.17% in 2022, and then decreased to 26.22% in 2024. CRPA was primarily isolated from sputum (54.48%) and bronchoalveolar lavage fluid (13.96%), and was predominantly distributed in the Intensive Care Unit (ICU, 39.70%), Emergency Department (18.13%), and Respiratory Department (10.82%). The majority of CRPA cases (85.37%) occurred in patients aged over 60 years, a proportion significantly higher than that in the non-CRPA group (79.38%) (<i>χ</i>² = 26.210, <i>P</i> &lt; 0.001). Among the CRPA, resistance rates to imipenem and meropenem remained high, at 97.09% and 77.54%, respectively, with no significant decrease observed over the six-year period. The resistance rate to amikacin was the lowest (24.18%) and showed a continuous declining trend (<i>P</i> &lt; 0.001).</p> Conclusion <p>From 2019 to 2024, the CRPA detection rate in this hospital remained high, indicating a serious drug resistance situation, particularly concentrated in the ICU and among the elderly population.</p> Clinical trial number <p>Not applicable.</p>