Aims & Objectives: To determine the clinical characteristics and outcome of severe community-acquired pneumonia (S-CAP) in children admitted to PICU of one referral center and to identify risk factors for poor outcomes. Methods Retrospective study that included children admitted to PICU of the Institute of Tropical Medicine of Asuncion, from 2004 to 2016 with a diagnosis of S-CAP. Clinical, microbiological and outcome were obtained from patient records, with emphasis in the analysis of duration of mechanical ventilation (MV), duration of stay in the PICU, and survival or death. Associations of variables with mortality were tested using standard statistical tools. Results During the study period, 222 children with S-CAP was admited to PICU, with a mean age of 38,1 + 47,8 months, and a male/female ratio of 1.7:1. Eighty-nine patients (40%) required VM. Bacteremia was observed in 42 patiens (19%). Staphyloccus aureus (27 patients, 12%) and Streptococcus pneumoniae (12 patients, 5%) were the most frequent organims isolated. The mean duration of stay in the PICU was 12,7 ± 11,6 days and the mortality was 18.9% (42 patients). Risk factors associated with mortality were leukopenia (WBC< 4500/mm3) [p<0,0009 RR 2.34 (1.3-4,2)], presence of bacteremia [p<0,00001 RR 2,88 (1,7-4,8)], staphyloccocal etiology [p=0.01 RR2,23 (1,2-4)], and mechanical ventilation requirement [p <0,000001 RR 60,35 (8,5 - 430.8)] Conclusions Severe pediatric pneumonia accounts for a significant number of PICU admissions in our country and is associated with significant mortality (18,9%),. The presence of leukopenia, bacteremia and mechanical ventilatory requirement were identified as early prognostic variables independently associated with poor clinical outcome.