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Purpose: Understanding the spectrum of ocular pathogens in a given geographic region is important for devising appropriate practical treatment. Therefore, we examined the pathogen spectrum and antibiotic resistance of microbial keratitis in northeast China. Methods: In this retrospective observational study, we reviewed the microbiology laboratory records of patients diagnosed with microbial keratitis in a tertiary eye hospital in Harbin, northeast China, between 2017 and 2019, and analysed the pathogen spectrum and antibiotic susceptibility. Results: We collected 462 specimens, of which 282 exhibited positive cultures. Among these cultures, 257 were bacterial and 25 were fungal. Of the 257 bacterial isolates, 214 (83.27%) were gram positive whereas 43 (16.73%) were gram negative. The most prevalent gram‐positive pathogen was coagulase‐negative staphylococcus (CoNS; 58.37%), followed by Staphylococcus aureus (S. aureus; 20.62%) and Streptococcus pneumoniae (2.33%). Of the gram‐negative bacterial isolates, 10 were Pseudomonas aeruginosa (3.89%). The most frequently detected ocular pathogens from fungal isolates were Fusarium species (40%). We also found more culture‐positive cases of bacterial keratitis in summer. Overall, 16.98% S. aureus and 64.00% CoNS isolates were methicillin resistant. These methicillin‐resistant bacteria were also more likely to be resistant to other antibiotics, with multidrug resistance found in 77.78% methicillin‐resistant S. aureus and 90.63% methicillin‐resistant CoNS. However, all gram‐positive isolates were sensitive to vancomycin and linezolid. Conclusion: Coagulase‐negative staphylococcus are the most common ocular pathogens in northeast China. We also show the prevalence of methicillin resistance and concurrent multidrug resistance among staphylococcal isolates. Monitoring the patterns of antimicrobial resistance could help in the management selection. [ABSTRACT FROM AUTHOR]