Objective: To investigate the surgical treatment strategies for infected pancreatic necrosis (IPN) and the situations of carbapenem-resistant enterobacteriaceae (CRE) infection. Methods: The clinical data of 118 IPN patients treated the Department of Biliopancreatic Surgery of Xiangya Hospital, Central South University from January 2010 to September 2017 were reviewed, and the cases with CRE infection was critically analyzed. Results: In the entire group of 118 IPN patients (3 cases did not undergo surgical treatment), the number of total surgical interventions was 328 times, with an average of 2.77 times per case, and the mortality rate was 20.3% (24/118), in which, the mortality rate in patients with bloodstream infection was significantly higher than in those without bloodstream infection [(39.5% (17/43) vs. 9.0% (7/75), P<0.001]. In the 31 cases (26.3%) with CRE infection, the number of total surgical interventions was 100 times, with an average of 3.22 times per case, of whom, 27 cases underwent a step-up approach treatment, and 4 cases underwent a step-down approach treatment, with a mortality rate of 32.3% (10/31). In IPN patients with CRE infection compared with IPN patients without CRE infection, the severity of acute pancreatitis was upgraded, mortality rate was increased, and length of ICU stay was prolonged significantly (all P<0.05). In addition, the mortality rate of IPN patients was gradually reduced over the past 8 years, but the proportion of CRE infection was markedly elevated during the past 4 years. Conclusion: IPN mainly depends on surgical treatment at present. CRE have become the main pathogenic bacteria of IPN, and are also associated with more severe conditions and longer the ICU stay. Step-up approach is becoming the mainstream surgical strategy for IPN associated with CRE.