Objective Analyze the risk and prognostic factors Multidrug-resistant Klebsiella pneumoniae(MDR-KPN) in patients with pneumonia in Respiratory Intensive Care Unit(RICU),in order to reduce clinical drug resistance provides guidance significance. Methods The data of 108 cases of MDR-KPN in patients with pneumonia were analyzed from Jan 2021 to Apr 2023 in RICU of The Second People Hospital of Hefei. The patients were divided into two groups (MDR-KPN and non-MDR-KPN)according to the sputum culture. The prediction model was established according to the results of logistic regression analysis. Results Comparing the groups found APACHE II scores, albumin, c-reactive protein, procalcitonin difference was statistically significant(P＜0.05). Univariate analysis suggested the use of parenteral nutrition, use acid suppression, protecting stomach medicine, carbon penicillium used alkene, cephalosporins, or enzyme inhibitors, application of bronchoscope, mechanical ventilation and center venipuncture were the risk factors of MDR-KPN infection. Multivariate Logistic regression analysis and ROC revealed that length of hospital stays in RICU，APACHE II scores, indwelling central venous catheter, carbapenems antibiotics used and mechanical ventilation were an Independent factor of MDR-KPN infection, and could accurately predict the occurrence of clinical MDR-KPN pneumonia. Conclusion Short hospital stay, reduced mechanical ventilation time, reduced central vein catheterization time, controlled APACHEII score, and reduced carbapenem use could reduce the occurrence of MDR-KPN pneumonia