Pneumonia is one of the most common and serious infections in children, especially those admitted to Pediatric Intensive Care Units (PICUs). Some children do not improve after at least five days of appropriate broad-spectrum antibiotic treatment. This condition is known as resistant or non-resolving pneumonia.

Flexible fiberoptic bronchoscopy (FFB) is a procedure that allows doctors to directly examine the airways and collect samples from the lungs for laboratory testing. This study aims to evaluate the role and usefulness of flexible bronchoscopy and bronchoalveolar lavage (BAL) in identifying the causes of resistant pneumonia in critically ill children.

The study will include children admitted to the PICU at Abu El-Reesh Children's Hospital, Cairo University, who show no clinical or radiological improvement after five days of first-line antibiotic therapy. The results of this study may help improve diagnosis, guide targeted treatment, and enhance outcomes in children with resistant pneumonia.

Inclusion Criteria:

• - Children aged more than 3 months and less than 18 years.

• Admitted to Pediatric Intensive Care Unit (PICU).

• Severe pneumonia defined as cough or difficulty breathing with at least one of the following:

  • Oxygen saturation < 90% on pulse oximetry
  • Severe respiratory distress
  • General danger signs (inability to drink, lethargy, convulsions)

• No clinical or radiological improvement after at least five days of first-line broad-spectrum antibiotic therapy.

• Informed consent obtained from parent or legal guardian.

Exclusion Criteria:

• Age less than 3 months or more than 18 years.
• Absolute contraindication to flexible bronchoscopy (severe refractory hypoxemia, hemodynamic instability, uncorrected bleeding disorder).

Pediatric patients admitted to the PICU at Abu El-Reesh Children's Hospital, Cairo University, diagnosed with resistant severe pneumonia and undergoing diagnostic flexible fiberoptic bronchoscopy