To investigate the cause of carbapenem-resistant Klebsiella pneumonia (KP) infection in a patient with immunodeficiency, and explore its pathogenesis and evaluate the efficacy.

The patient was a middle-aged man, 58 years old, who was an immunodeficiency host (ICH) after liver transplantation, and developed a rapidly progressive carbapenem-resistant Klebsiella pneumonia (CRKP) lung infection. Taking the diagnosis and treatment process as the main line, host risk factors, time and space cross medical environment analysis and pathogenesis analysis, the source of pathogens were enrolled to distinguish the infection origin. The second-generation gene sequencing was applied to detect drug-resistant genes in order to conduct precise antibiotic treatment.

To trace the initial lesion of imaging as a breakthrough point, the patient was diagnosed as postoperative CRKP nosocomial infection. Five patients (4 strains from sputum and 1 strain from urine) with KP were screened out. Ten high-risk cases were screened for anal swab, and one case was positive for CRKP and considered to be colonized bacteria. Total of 50 samples of environmental hygiene were collected, and one CRKP sample was detected in bed bar surface in RICU. This patient was judged as endogenous infection of hospital CRKP. The drug-resistant genes contained KPC enzymes and metalloenzymes was not detected. Zavicefta was selected to control CRKP infection and various prevention measures were carried out and achieved good clinical effects.

ICHs have a high risk of nosocomial infection of drug-resistant bacteria and poor prognosis. The nosocomial analysis should be brought into clinical practice, and accurate treatment of ICH hospital-acquired pneumonia should be performed to prevent horizontal or vertical spread of CRKP.