Objective: To explore the pathogen distribution and major bacterial resistance in children with severe community acquired pneumonia (CAP). Methods: 512 severe CAP children were grouped according age and onset seasons. Sputum specimen in deep airway of all the children were collected to analyze the pathogen distribution and major bacterial resistance. Results: 408 children were positive for pathogen distribution among 512 children and the positive rate was 79.7%, among which mixed infection was the most. A total of 675 pathogens were detected, of which bacteria were 372 strains (55.1%) and among which gram-negative bacteria were the main pathogens. Bacterial, viral, fungal, chlamydia trachomatis infection mainly occurred in infancy stage and winter, while mycoplasma pneumoniae infection mainly occurred in early school age and summer. In gram-positive bacteria, streptococcus pneumoniae and staphylococcus aureus were sensitive to vancomycin and linazolamide; The drug resistance rate of streptococcus pneumoniae to erythromycin, tetracycline and clindamycin were more than 80%; The drug resistance rate of staphylococcus aureus to penicillin, erythromycin, clindamycin and ampicillin were more than 50%. In gram-negative bacteria, the sensitivity of escherichia coli and klebsiella pneumoniae to meropenem, ertapenem and imipenem were all over 90%; The drug resistance rate of haemophilus influenzae to ampicillin, compound neo-nomine, cefaclor and cefuroxime were over 60%; The drug resistance rate of escherichia coli and klebsiella pneumoniae to ampicillin, cefotaxime, ceftriaxone and cephalosporin were over 60%. Conclusions: Bacteria are the main pathogen in children with severe CAP, among which mixed infections were more common, antibiotics should be carefully used in clinic.