碳青霉烯酶和肺炎克雷伯杆菌碳青霉烯酶:当前水平

Carbapenemases and Klebsiella pneumoniae carbapenemases:state-of-the-art

多药抵抗的肠杆菌伴随一系列碳青霉烯酶的出现给相关疾病的临床诊断和治疗带来了挑战。肺炎克雷伯杆菌碳青霉烯酶(Klebsiella pneumoniae carbapenemases,KPC)具有水解几乎所有β-内酰胺类包括青霉素、头孢菌素、单环β-内酰胺类和碳青霉烯类抗生素的能力。当前抗微生物表型易感性试验检测KPC的结果不可靠,但改良的Hodge试验和PCR可用于对KPC的检测。治疗碳青霉烯类耐药菌感染可选择多粘菌素、磷霉素、替加环素和多尼培南,也可以尝试一些多药联合或延长疗程的治疗。严格的感染控制措施对阻断感染的传播也是必要的。

The emergence of multidrug-resistant Enterobacteriaceae mediated by a series of carbapenemases creates a challenge in the diagnosis and treatment. Klebsiella pneumoniae carbapenemases （KPC） possess the ability to hydrolyze almost all beta-lactam drugs ineluding penicillins, eephalosporins, monobaetams and carbapenems. Current phenotypie antimierobial susceptibility tests are not reliable to detect KPC. Modified Hodge test and PCR-based assay have been used to confirm the existence of KPC. Colistin, fosfomyein, tigeeycline and doripenem are the current therapeutic options for earbapenems-resistant bacterial infection. Antimierobial combination therapy or prolonged duration of treatment is another choice. Better antibiotic stewardship and infection control measures are also needed to prevent the spread of KPC-producing Enterobactenaceae.