OBJECTIVE: To study the characteristics of endotracheal pathogens in children with ventilator-associated pneumonia(VAP) in order to establish more e ffective treatment and prophylaxis regimens. METHODS: Endotr acheal tube secretion s were collected for bacterial and/ fungal culture and drug-sensitivity testing in 34 children with VAP. RESULTS: There were 106 bacterial strains cultured from the 34 patients. Seventy-two(67.9%) cultures yielded Gram-negative bacteria, of wh ic h 17 were Acinetobacter baumanii, 20 Pseudomonas aeruginosa, 17 Klebsiella pneum oniae, 6 Enterobacteriaceae, 4 Stenotrophomonas maltophilia and 8 Escherichia coli. There were 6(5.7%) Gram-positive cocci, including 5 type A Streptococcus a n d 1 Staphylococcus aureus. Twenty-eight cultures were positive for fungi. Sixte e n patients had mixed infections. Eighty percent of the Enterobacteriaceae and 50 % of the Acinetobacter baumanii were resistant to third generation cephalosporin s and aminoglycosides; 88.9% of the Stenotrophomonas maltophilia were resistant to imipenem, and 83.3% of the Gram-positive cocci to penicillin. CONCLUSIONS: Gra m-negative bacteria account for the majority of pathogens in children with VAP.Fungal infections should not be disregarded. Antibiotics should be appropriately used according to drug-sensitivity testing.