Abstract: OBJECTIVE To investigate the the pathogenic bacteria and airway inflammatory factors in children with community-acquired pneumonia (CAP) and the influencing factors of therapeutic efficacy. METHODS Totally 137 children with CAP and positive sputum culture diagnosed in Huaihe Hospital of Henan University were selected between Jun. 2019 and Sep. 2021, and the results of pathogen identification were recorded. According to the clinical efficacy of children after 7 days of treatment, they were divided into 99 cases of effective group and 38 cases of ineffective group. The levels of airway inflammatory factors nuclear factor-κB (NF-κB), galectin 3 (Gal-3) and chitinase-3-like-1 protein (YKL-40) in induced sputum were compared between the two groups before and after treatment. The correlation between airway inflammatory factors and disease severity Clinical Pulmonary Infection Score (CPIS), Pediatric Critical Illness Score (PCIS) was analyzed, and the risk factors affecting the efficacy and the predictive value of airway inflammatory factors on the efficacy were explored. RESULTS A total of 158 strains of pathogenic bacteria were isolated from 137 children with CAP, of which 92 strains of Gram-negative bacteria accounted for 58.23%, and 66 strains of Gram-positive bacteria accounted for 41.77%. The main pathogenic bacteria were Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae. Before and after treatment, the NF-κB, Gal-3 and YKL-40 in the effective group were lower than those in the ineffective group (P<0.05), and the decreases of NF-κB, Gal-3 and YKL-40 before and after treatment were greater than those in ineffective group (P<0.05). Multiple bacterial infections, CPIS score and PCIS score were the risk factors affecting the antimicrobial efficacy of children with CAP (P<0.05). The areas under the receiver operating characteristic (ROC) curve of NF-κB, Gal-3 and YKL-40 in predicting the ineffectiveness of antibacterial therapy in children with CAP was 0.760, 0.716 and 0.767, respectively. CONCLUSION Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were the main pathogenic bacteria of CAP in children. Multiple bacterial mixed infections could affect the therapeutic efficacy of antibacterial drugs in children. In addition, NF-κB, Gal-3 and YKL-40 might be used as early predictors of efficacy.