Abstract: OBJECTIVE To explore the clinical distribution and epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a pediatric hospital from 2019 to 2023, and to provide a basis for the prevention and control of CRKP infections in children. METHODSA retrospective study was conducted to collect clinical and microbiological data on Klebsiella pneumoniae (KP) detected in children hospitalized in Anhui Provincial Children's Hospital from Jan. 2019 to Dec. 2023. Based on drug susceptibility results, the children were divided into a CRKP group and a carbapenem-sensitive KP (CSKP) group. We analyzed the detection rate, annual changes, composition of hospital-associated infection, specimen sources and infection sites of CRKP. RESULTSA total of 475 children with KP infections were enrolled, with 519 non-duplicate specimens obtained, of which 103 (125 specimens) were tested with CRKP. The overall isolation rates were 21.68% and 24.08%, calculated by cases and specimens, respectively. CRKP had a higher isolation rate in the pediatric intensive care unit (PICU) and neonatal surgery departments. The detection rate was higher in children who received carbapenem antimicrobial agents after hospitalization compared to those who did not (P<0.001). No significant trend was observed in the isolation rate of CRKP or its compositional ratio in hospital-associated infections from 2019 to 2023. CRKP specimens were mainly derived from blood, urine and respiratory secretions. Hospital-associated infections were primarily bloodstream infections and urinary system infections. CONCLUSIONS CRKP is one of the significant drug-resistant bacteria in pediatric hospitals. Children in the PICU are a key population for prevention and control. Bloodstream infections are the main type of hospital-associated infection. It is necessary to strengthen the management of antimicrobial agents and high-risk aspects of hospital-associated infections.