【摘要】目的：收集同济大学附属东方医院临床分离出的肺炎克雷伯菌，对其进行检测及分析，筛选出其中耐碳青霉烯类药物的肺炎克雷伯菌，探讨肺炎克雷伯菌在临床各个科室分布情况及耐药性。比较用纸片扩散法、仪器法、E-test法检测临床分离株中耐碳青霉烯肺炎克雷伯菌的检出率和敏感性。为临床中选择检测肺炎克雷伯菌耐药的方法提供参考依据。 方法：收集同济大学附属东方医院2022年10月至12月各临床科室送检的各类标本，分离出肺炎克雷伯菌。使用纸片扩散初筛法，筛选出对亚胺培南、厄他培南或美罗培南中至少一种抗生素耐药的肺炎克雷伯菌，共有82株肺炎克雷伯菌，其中有49株为耐碳青霉烯类抗生素的肺炎克雷伯菌（CRKP）。对肺炎克雷伯菌在各科室的检出率、分布特点、标本来源、抗生素耐药性以及碳青霉烯类抗生素耐药性进行分析。分别用仪器法、浓度梯度法（E-test法）和纸片扩散法检测CRKP对亚胺培南的敏感性，分析三种药敏方法所存在的差异。 结果：82株肺炎克雷伯菌标本主要来自神经内科、神经外科、肝胆胰外科、中心监护室、泌尿外科、内分泌科、功能神经科、急诊内科等，分布前三位分别为神经内科（33例，占30.7%）、神经外科（8例，占9.6%）、肝胆胰外科（7例，8.4%）；送检标本以痰液（51.2%）、中段尿（19.5%）为主。有49例对碳青酶烯类药物耐药的肺炎克雷伯菌。其中，KPC阳性菌株39例（占79.6%），NDM阳性菌株6例（占12.2%）。仪器法、E-test法、纸片扩散法检测CRKP对亚胺培南的敏感率分别为，具有较高的一致性和敏感性。纸片扩散法KB值与E-test法MIC值之间方差分析P＞0.05,提示KB值与MIC值不具有线性关系。 结论：我院临床分离出的肺炎克雷伯菌携带多种耐药基因，碳青霉烯耐药主要由KPC、NDM基因引起，对数十种临床常用抗菌药物耐药。仪器法、纸片扩散法以及E-test法都显示CRKP对亚胺培南具有较高的敏感性。不同的药敏检测方法各自具备一些独特的优势和不足之处。因此，我们有必要加强对肺炎克雷伯菌的监测和耐药筛查，并为临床提供合理选择检测方法的指导，以遏制CRKP在医院内的大规模传播和流行。

[Abstract] Objective: To investigate the clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae in East Hospital Affiliated to Tongji University. To compare the detection rate and sensitivity of carbapenem-resistant Klebsiella pneumoniae isolates by several methods. To provide reference for the selection of clinical Klebsiella pneumoniae resistance detection methods. Methods: Klebsiella pneumoniae isolated from various specimens submitted for clinical examination in East Hospital Affiliated to Tongji University from October to December 2022 were collected, and imipenem, ertapenem or meropenem resistant Klebsiella pneumoniae were screened by paper diffusion preliminary screening method. 49 carbapenem-resistant Klebsiella pneumoniae (CRKP) were screened out of 82 strains. The detection rate of Klebsiella pneumoniae, distribution of departments, source of specimens, antimicrobial resistance and resistance to carbapenems were analyzed. The sensitivity of CRKP to imipenem was detected by instrument method, concentration gradient method (E-test method) and disk diffusion method, and the differences between the three methods were analyzed. Results: 82 strains of Klebsiella pneumoniae were mainly collected from neurology, neurosurgery, hepatobiliary and pancreatic surgery, central care unit, urology, endocrinology, functional neurology, emergency medicine, etc. The top three distribution were neurology (33 cases, 30.7%), neurosurgery (8 cases, 9.6%), hepatobiliary and pancreatic surgery (7 cases, 8.4%). The samples were mainly sputum (51.2%) and midstream urine (19.5%). Carbapenase-resistant Klebsiella pneumoniae: 49 cases. There were 39 KPC-positive strains (79.6%) and 6 NDM positive strains (12.2%). The sensitivity rates of CRKP to imipenem by instrument method, E-test method and disk diffusion method are respectively, showing high consistency and sensitivity. Anova analysis between KB value of disk diffusion method and MIC value of E-test method P> 0.05, indicating that there is no linear relationship between KB value and MIC value. Conclusion: Klebsiella pneumoniae clinically isolated in our hospital carried a variety of drug resistance genes, carbapenem resistance was mainly caused by KPC and NDM genes, and was resistant to dozens of commonly used clinical antibiotics. The sensitivity of CRKP to imipenem was higher by instrument, disk diffusion and E-test. Different drug sensitivity detection methods have their advantages and disadvantages. Surveillance and drug resistance screening of Klebsiella pneumoniae should be strengthened and clinical rational drug use should be guided to prevent the spread of CRKP in hospitals.