Objective To analyze clinical characteristics, pathogen distribution, and drug sensitivity in neck abscess patients with or without hypoalbuminemia, providing reference for clinical treatment. Methods Clinical data of 934 patients who underwent neck abscess incision and drainage surgery in our hospital from January 2010 to January 2023 were retrospectively analyzed. Patients were divided into neck abscess with hypoalbuminemia group (NAH group) and neck abscess without hypoalbuminemia group (NANH group) based on serum albumin levels. Clinical characteristics, pathogen distribution, and drug sensitivity were compared between the two groups. Results There were 207 cases in NAH group and 727 cases in NANH group. Significant differences were observed between the two groups in age, smoking history, alcohol consumption history, length of hospital stay, hypertension, diabetes, laryngeal obstruction, and liver and kidney dysfunction (all P＜0.05). The infection days of neck abscess were negatively correlated with serum albumin level. The main pathogen in the NAH group was Klebsiella pneumoniae, while in the NANH group it was Staphylococcus aureus. Drug sensitivity results showed that in the NAH group, sensitivity was highest to tobramycin, imipenem, and levofloxacin, while in the NANH group, sensitivity was highest to linezolid, vancomycin, quinupristin/dalfopristin, tigecycline, nitrofurantoin, minocycline, and vibramycin. Conclusion Neck abscess patients with hypoalbuminemia have specific clinical characteristics and require individualized treatment strategies. In the absence of drug sensitivity results, tobramycin, imipenem, and levofloxacin are recommended for the NAH group, while linezolid, vancomycin, quinupristin/dalfopristin, tigecycline, nitrofurantoin, minocycline, and vibramycin can be considered for the NANH group