Viruses have historically been the most common cause of communityacquired pneumonia (CAP) in children. However, microbial co-infection, especially bacteria, is a matter of great concern to clinicians because of its association with antibiotic use. Objectives: To determine the rate of microbial co-infections and microbiological agents in children with severe CAP by Real-time PCR. To identify the causative agents of severe pneumonia in children by Realtime PCR technique. Materials and method: Cross-sectional description. The study was conducted on 239 children with severe CAP admitted to Can Tho Children's Hospital from March 2020 to February 2021. Children were analyzed nasotracheal aspiration (NTA) specimens by Real-time PCR for 70 agents. Results: The rate of the agent through Real-time PCR was very high (93.6%). The majority of patients had microbial co-infection (85%), in which, virus-bacterial coinfection accounted for the highest rate (67.5%), followed by bacterial-bacterial co-infection (16.2%). The three main bacterial agents detected by Real-time PCR were Streptococcus pneumoniae, Haemophilus influenzae non-type b, and methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: Bacterial co-infection in children with severe pneumonia was quite high, so the life-saving treatment for severe pneumonia should be antibiotics. Treatment should focus on antibiotics that are specific to the three main bacteria detected