Pneumonia in Children with Congenital Heart Disease: Bacterial Spectrum and Risk of Bacteremia Omnia Salah Esmail1*, Besheir AbdAlla Hassan1, Dina Tawfeek Sarhan1, Asmaa Ahmed Saad2, Eman Mohammed El- Hindawy1 1 Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt. 2 Department of clinical pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Abstract Background: Community-acquired pneumonia (CAP) is widely acknowledged as the leading cause of morbidity and mortality among children worldwide, particularly in developing nations. Children with congenital heart disorders (CHD) are more likely to have pneumonia and require repeated hospitalization. Aim of the study : To determine the most frequent microorganism responsible for pneumonia in children with and without CHD, as well as the prevalence of bacteremia in such cases, and whether or not CHD raises the risk of bacteremia in children with pneumonia. methods We conducted our prospective cohort study in Department of Pediatrics, Faculty of Medicine, Zagazig University on 50 children who divided equally into 2 groups; group Ⅰ contained 25 children with pneumonia in patients with CHD, group Ⅱ contained 25 non-cardiac children with pneumonia. All underwent complete blood count (CBC), chest x ray (CXR), echocardiogram (ECHO), sputum culture, and blood culture Results Patients of CHD had significant more frequent previous hospital admissions by pneumonia. Among the children in group I, the blood culture results revealed no growth in 15 cases (60%), and klebsiella pneumoniae in 3 cases (12%), while in group Ⅱ, the result revealed no growth in 11 cases (44%), klebsiella pneumoniae in 5 cases (20%) and there was no statistically significant difference between both groups. Conclusion Klebsiella pneumoniae was the most prevalent pathogen responsible for pneumonia in children with and without CHD, and linezolid was the most sensitive antibiotic. In children who have pneumonia, CHD might attribute to higher risk of bacteremia, however, we couldn’t prove that in our study. Keywords: Pneumonia; Congenital Heart Disease; Bacteremia; Pediatric