The risk factors and coping strategies of severe community-acquired pneumonia (SCAP) in chemotherapy induction period of acute leukemia were investigated. Eighty-six patients with CAP in chemotherapy induction period of acute leukemia in Dezhou Hospital from March 2014 to February 2017 were selected and divided into observation group (SCAP group, n=45) and control group (non-SCAP group, n=41) according to the acute physiology and chronic health evolution II (APACHE II) score. The blood, sputum, nasopharyngeal secretion and pleural effusion samples were collected from patients in both groups, and the samples were detected for pathogens, followed by the analysis of relevant factors. The dynamic changes in the sequential organ failure assessment (SOFA) score, procalcitonin (PCT), D-dimer (D-D) and C-reactive protein (CRP) levels in patients were observed before and after the corresponding treatment strategies were taken. The total distribution ratio of pathogens from high to low in the two groups was as follows: bacterium, virus, fungus, mycoplasma and chlamydia trachomatis; there was no significant difference between the two groups (P>0.05). Logistic regression analysis showed that the repeated infection (OR=3.315, P=0.005), multi-resistant bacterial infection (OR=1.915, P=0.008) and D-D (OR=1.936, P=0.009) were independent risk factors for SCAP (P<0.05). After different coping strategies were taken, the SOFA score, PCT, D-D and CRP levels in the two groups were significantly decreased, and they were obviously higher in observation group than those in control group (P<0.05). Repeated infection, D-D level and multi-resistant bacterial infection are the risk factors affecting the SCAP in chemotherapy induction period of acute leukemia. The coping strategies can effectively relieve the patient's condition, reduce the severity of disease and improve the survival rate of patients.