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The nasal septal abscess (NSA) is a rare but potentially fatal disease causing intracranial infection. Treatments for NSA include antibiotics, surgical incision and drainage. Diabetes mellitus (DM) is a risk factor for NSA. Therefore, we assessed the pathogenic bacterial composition of NSA in diabetic patients. We analyzed the Chang Gung Memorial Hospital database to collect 79 NSA patients who received surgical incisions and drainage from 2004 to 2015. We divided them into DM and non-DM groups for analysis. We integrated the bacteria cultured from each patient, listed the top three with the highest frequency and divided the bacterial species into facultative anaerobes or aerobes and anaerobes. The microbiological cultures revealed mono-microbial infection in most of the cases. The top three facultative anaerobes or aerobes with the highest frequency of NSA-DM were <i>Klebsiella pneumoniae</i> (37.5%), methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA; 25%) and methicillin-resistant <i>Staphylococcus aureus</i> (MRSA; 12.5%). The top three for NSA-non-DMs were MSSA (24%), MRSA (20%) and <i>Pseudomonas aeruginosa</i> (16%). The top three anaerobes causing NSA were <i>Prevotella intermedia</i> (25%), <i>Peptostreptococcus</i> species (12.5%) and <i>Propionibacterium acnes</i> (12.5%) in DM patients. The top three in non-DM patients were <i>P. intermedia</i> (25%), <i>P. acnes</i> (16.7%) and <i>Fusobacterium nucleatum</i> (12.5%). When treating NSA in diabetic patients, clinicians should choose empirical antibiotics for <i>K. pneumoniae</i> and <i>P. intermedia</i>, and when treating patients with NSA-non-DM, MSSA and <i>P. intermedia</i> should be considered first.