〔Abstract〕 Objective To investigate the pathogen distribution of severe community-acquired pneumonia (CAP) in children and provide a reference basis for the clinical diagnosis and treatment of the disease. Methods A total of 473 children with severe CAP who were hospitalized in Zhangzhou Hospital Affiliated to Fujian Medical University between January 2019 and December 2020 were selected as the study subjects, of which, 273 cases were included in 2019 and 200 cases were included in 2020. The data of all children were statistically analyzed, and venous blood samples and sputum samples were collected for M. pneumoniae surveillance, bacterial and viral identification, Statistical analysis was performed on the results. Results A total of 408 pathogens were identified in 473 children (86.26%); The detection rate of pathogenic variants in children was 86.81% (237 / 273) in 2019 and 85.50% (171 / 200) in 2020; There was no significant difference between the pathogen detection rates of children in different years (P > 0.05; However, there was no significant difference in the detection rates of bacteria, fungi and viruses between the different years (P > 0.05), and the detection rate of M. pneumoniae in 2019 children was higher than that in 2020 children (P < 0.05). In 2019, bacteria, fungi and viruses were detected, respectively, with Haemophilus influenzae, Candida albicans and influenza B accounting for the highest proportion; in 2020, Klebsiella pneumoniae, Candida albicans, and respiratory syncytial virus accounted for the highest proportion, respectively. Conclusion The infecting pathogens of severe CAP in children are mainly bacteria.