Characteristics of Klebsiella pneumoniae and carbapenem-resistant Klebsiella pneumoniae clinical isolates from COVID-19 patients: a single-center retrospective analysis in a tertiary hospital, China.

Background: The COVID-19 pandemic has exacerbated the complexity of antimicrobial resistance (AMR) challenges. This study aimed to quantify risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) acquisition in COVID-19 patients, compare resistance profiles and laboratory biomarkers between carbapenem-susceptible K. pneumoniae (CS-KP) and CRKP strains, and identify clinical indicators predictive of CRKP co-infection.

Methods: We conducted a retrospective analysis of COVID-19 patients with KP-positive cultures admitted to a tertiary hospital in China between January 2020 and May 2024. Antimicrobial susceptibility testing and multivariable logistic regression were employed to evaluate resistance patterns and risk factors.

Results: Among 342 COVID-19 patients with KP-positive, 262 (76.6%) were CSKP and 80 (23.4%) CRKP. Hypertension, prolonged hospitalization, and ICU admission were identified as independent risk factors for CRKP acquisition. CRKP group patients exhibited significantly worse laboratory tests, including elevated inflammatory markers, coagulopathy, and renal dysfunction, providing clinical markers for suspecting the presence of multi-drug resistant bacteria.

Conclusions: Our findings reveal KP resistance profiles under COVID-19 pressures and underscore the necessity of early microbiological confirmation and precision antibiotic use.