本研究收集了上海市同济大学附属东方医院2022年10月—2022年12月临床分离的肺炎克雷伯菌(Klebsiella pneumoniae，KPN)共82株，采用实时荧光聚合酶链反应(polymerase chain reaction，PCR)检测菌株耐碳青霉烯酶基因型，并采用酶抑制剂增强试验检测菌株耐碳青霉烯酶表型；同时，分别使用微量肉汤稀释法和纸片扩散法检测头孢他啶/阿维巴坦(ceftazidime-avibactam，CZA)对82株肺炎克雷伯菌的最低抑菌浓度(minimal inhibitory concentration，MIC)和抑菌圈直径，旨在评估纸片扩散法检测头孢他啶/阿维巴坦药敏方法在临床替代微量肉汤稀释法的可行性。结果显示，该院分离的82株肺炎克雷伯菌株中耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant klebsiella pneumoniae, CRKP)有47株，主要分布于神经内科、神经外科和肝胆胰外科；肺炎克雷伯菌耐药基因型结果(实时荧光PCR法)与菌株碳青霉烯酶耐药表型(酶抑制剂增强试验法)结果一致；两种药敏方法对比显示，纸片扩散法与微量肉汤稀释法检测耐碳青霉烯类肺炎克雷伯菌对头孢他啶/阿维巴坦的药敏结果一致性较高，分类一致性(category agreement，CA)分别为98.3%、99.7%，重大错误率(major error，ME)均为0。本研究证实，纸片扩散法可用于临床检测CZA对肺炎克雷伯菌的药敏性，但抑菌圈直径为20～22 mm的菌株仍须采用肉汤稀释法进行复核。

A total of 82 strains of Klebsiella pneumoniae (KPN) clinically isolated from East Hospital Affiliated to Tongji University in Shanghai from October to December 2022 were collected in this study. Real-time fluorescent polymerase chain reaction (PCR)and enzyme inhibitor enhanced test were used to detect carbapenemase-producing genotypes of the strains. Simultaneously, the minimum inhibitory concentration (MIC) and inhibitory zone diameter of ceftazidime-avibactam (CZA) against these strains of Klebsiella pneumoniae were detected by microbroth dilution method and Kirby-Bauer disk diffusion method, respectively, to verify whether disk diffusion method could serve as a reliable alternative to the microbroth dilution method for CZA susceptibility testing. The results demonstrated complete concordance between carbapenemase genotypes (real-time PCR) and phenotypes (enzyme inhibitor enhancement test). Comparative analysis of the two susceptibility testing methods revealed high agreement between disk diffusion and microbroth dilution. The results of the two disk diffusion methods and the micro-broth dilution method revealed high agreement with categorical agreement (CA) rates of 98.3% and 99.7% and no major errors (ME ＝ 0). This study confirmed that the disk diffusion method can be used to detect the drug susceptibility of CZA to KPN. However, it still needs to be checked by broth dilution method if the inhibition zone range is within 20-22 mm.