Abstract: Objective To study the risk factors for prognosis of acute respiratory distress syndrome (ARDS) and its drug resistance to pathogenic bacteria. Methods The risk factors for prognosis, pathogenic bacteria and their drug resistance in 81 patients with ARDS due to pulmonary admitted to our hospital from January 2005 to August 2012 were analyzed. Results The mortality of the patients was 50.6%. Multivariate logistic regression analysis showed that sequential organ failure assessment(SOFA) score, oxygenation index (PaO₂/FiO₂ ratio) and ICU stay time< 7 days were the risk factors for the prognosis of ARDS due to pulmonary infection.Of the detected 73 strains of pathogenic bacteria, 62 (82.2%) including 40 strains (66.7%) of Pseudomonas aeruginosa were Gramnegative with a drug resistance rate> 95% to the second and third generation of cephalosporin and carbapenems. Conclusion SOFA score, oxygenation index (PaO₂/FiO₂ ratio) and ICU stay time< 7 days are the risk factors for prognosis of ARDS due to pulmonary infection. Gram-negative bacilli are the main pathogenic bacteria. The positive detection rate of multidrug-resistant Pseudomonas aeruginosa is rather high.