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Haidi Karam-Allah Ramadan,1 Manal A Mahmoud,2 Mohamed Zakaria Aburahma,1 Amal A Elkhawaga,3 Mohamed A El-Mokhtar,3 Ibrahim M Sayed,3,4 Amal Hosni,5 Sahar M Hassany,1 Mohammed A Medhat1 1Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Department of Pathology, School of Medicine, University of California, San Diego, CA, USA; 5Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Haidi Karam-Allah RamadanDepartment of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, EgyptEmail haidikaram@aun.edu.egBackground: The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide devastating effect with a diagnostic challenge. Identifying risk factors of severity aids in assessment for the need of early hospitalization. We aimed to demonstrate, for the first time, the clinical, laboratory and radiological characteristics of coronavirus disease 2019 (COVID-19) patients, to identify the predictors of severity and to describe the antimicrobial resistance profile in patients from Upper Egypt.Materials and Methods: Demographic characters, clinical presentations, laboratory, and radiological data were recorded and analyzed. Presence of other respiratory microorganisms and their sensitivity patterns were identified using the VITEK2 system. Resistance-associated genes were tested by PCR.Results: The study included 260 COVID-19 patients. The majority were males (55.4%) aged between 51 and 70 years. Hypertension, diabetes, and ischemic heart disease were common comorbidities. Main clinical manifestations were fever (63.8%), cough (57.7%), dyspnea (40%) and fatigue (30%). According to severity, 51.5% were moderate, 25.4% mild and 23% severe/critical. Lymphopenia, elevated CRP, ferritin, and D-dimer occurred in all patients with significantly higher value in the severe group. Age > 53 years and elevated ferritin ≥ 484 ng/mL were significant risk factors for severity. About 10.7% of the COVID-19 patients showed bacterial and/or fungal infections. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were the predominant isolated bacteria while Candida albicans and Candida glabrata were the predominant isolated fungi. All Staphylococci were methicillin-resistant and carried the mecA gene. Gram-negative isolates were multidrug-resistant and carried different resistance-associated genes, including NDM-1, KPC, TEM, CTX-M, and SHV.Conclusion: Older age and elevated serum ferritin were significant risk factors for severe COVID-19. Bacterial co-infection and multidrug resistance among patients with COVID-19 in Upper Egypt is common. Testing for presence of other co-infecting agents should be considered, and prompt treatment should be carried out according to the antimicrobial sensitivity reports.Keywords: COVID-19, clinical characteristics, ESBL, KPC, NDM-1, risk factors, disease severity, Upper Egypt