Abstract
Background:
Bronchial asthma is a complex, chronic condition of the airways and is one of the most prevalent pediatric illnesses worldwide and causing a significant, considerable amount of morbidity and mortality.

Aim:
This study aimed to identify bacterial species in the upper airway of asthmatic children, determine their antimicrobial susceptibility, and explore the role of bacterial infections in asthma exacerbations.

Methods:
This cross-sectional study included 369 children (195 females and 174 males) aged between 1 month and 15 years (mean age: 7.95 ± 3.95 years) from pediatric respiratory departments in hospitals across Tripoli, Libya, between January to April 2025. Demographic and clinical data were collected using structured questionnaires. Bacterial were samples collected nasopharyngeal swabs and sputum's. The bacterial isolates were identified using conventional identification techniques in accordance with normal microbiological protocols after the samples were cultivated. A Statistical analysis were conducted based on available data to examine microbial relationship to asthma in performed to examine associations between bacterial colonization, age, and gender.

Results:
Among 369 children, 195 (52.8%) were females, and 174 (47.2%) were males. The mean age of the children with asthma was (7.95 years ± 3.97 SD) (Range: month–15 years). Gram-positive bacteria accounted for 67.21% of isolates, while Gram-negative bacteria accounted for 32.79%. The most commonly isolated organism was Staphylococcus aureus (161; 43.63%), followed by Streptococcus pneumonia (67; 18.16% (Haemophilus influenza (61; 16.53%), Moraxella catarrhalis (60; 16.26%), and Streptococcus pyogenes (20: 5.42%). The highest culture positivity was observed in the 6–10 year age group, whereas the lowest was in infants aged 1–6 months. Most common organism grown in culture was S. aureus 161 (43.63%) followed by S. pneumonia 67 (18.16%), H. influenza 61 (16.53%), M. catarrhalis is 60 (16.26%) and S. pyogenes 20 (5.42%), Frequency distribution of isolated bacteria among children with asthma according to age, where the percentage of cultural positivity was highest in the age group 6–10 years, and the lowest rate of infection was recorded among age 1–6 months.

Conclusion:
Indicate these findings imply that bacterial colonization contributes to the pathogenesis of acute asthma and plays a significant role in Takes. Future research should focus on prevention and treatment strategies.

Key words: Asthma; Childhood; Bacterial colonization; Exacerbations in children; Antibiotic resistance.