ObjectiveTo evaluate pathogens and antimicrobial resistance of pathogens causing refractory pneumonia in children. MethodsChildren with refractory pneumonia who admitted to a hospital between May 2008 and December 2014 were performed  bronchoscopy, and bronchoalveolar lavage fluid (BALF) were performed bacterial culture and antimicrobial resistance testing.Results1 693 patients were recruited in the study,  273 bacterial isolates were isolated from BALF specimens of 226 children, grampositive bacteria accounted for 38.10%(104/273), the  main grampositive bacteria were Streptococcus pneumoniae(n=71) and Staphylococcus aureus(n=23); gramnegative bacteria accounted for 58.24%(159/273),including 44 isolates of Haemophilus parainfluenzae，28 Klebsiella pneumoniae，19 Escherichia coli, and 17 Pseudomonas aeruginosa; 10 isolates of fungi were also detected,8 of which were  Candida albicans.The sensitivity  of Streptococcus pneumoniae to quinolones,ceftriaxone and cefotaxime were high.  Methicillinresistant Staphylococcus aureus (MRSA) positive rate was 26.32%. ESBLsproducing rate of Haemophilus parainfluenzae and Klebsiella pneumoniae was 32.72% and 62.96%respectively.ConclusionThe major pathogens causing refractory pneumonia were Streptococcus pneumoniae and Haemophilus parainfluenzae, empirical treatment should be conducted accordingly, antimicrobial resistance should be considered if therapeutic effect is poor, and targeted therapy should be performed according to cultured results and antimicrobial susceptibility testing result.