Publication date: Jun 27, 2025

Secondary infection is a common complication in patients diagnosed with coronavirus disease 2019 (COVID-19) and often leads to complexity in clinical treatment. Due to the irregular use of prescribed antibiotics, carbapenem-resistant Enterobacterales (CRE) have gradually emerged. Empirical antibiotic treatment often encounters obstacles in patients with COVID-19 coinfected with CRE. This study aimed to establish a protocol for carbapenemase detection to guide the standardized use of antibiotics and improve patient prognosis. The performance of GeneXpert Carba-R and immunochromatography were evaluated for the detection of carbapenemases in 115 gram-negative isolates to develop an optimal scheme for carbapenemase detection. The clinical characteristics of 44 patients diagnosed with COVID-19 complicated by CRE were retrospectively analyzed, and clinical outcomes before and after implementation of the proposed strategy were compared. The overall accuracy, sensitivity, and specificity of the 2 respective methods were as follows: 98. 3%, 98. 9%, and 95. 4%; and 97. 4%, 96. 8%, and 100%. A proposed scheme combining the advantages of the 2 carbapenemase detection methods was developed through a comprehensive comparison. Results demonstrated that patients with COVID-19 complicated by CRE were significantly older than those with carbapenem-susceptible Enterobacterales infection (P 

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