肺炎克雷伯菌对碳青霉烯类抗菌药物的主要耐药机制及治疗策略

Drug Resistance Mechanism and Treatment Progress of Klebsiella pneumoniae to Carbapenem-resistant Klebsiella pneumoniae

肺炎克雷伯菌(Klebsiella pneumoniae,Kpn)是临床常见的条件致病菌。碳青霉烯类药物抗菌活性强,对各种类型的β-内酰胺酶高度稳定,是治疗Kpn感染的最佳抗菌药物。然而,随着碳青霉烯类抗菌药物的使用,对碳青霉烯耐药Kpn(Carbapenem-resistant Klebsiella pneumoniae,CR-Kp)在临床的分离率逐年升高。CR-Kp感染治疗可供选择的抗菌药物非常有限,这给临床治疗带来很大挑战。本文主要从碳青霉烯酶的产生、细胞膜孔道蛋白缺失或者数量不足两个方面对CR-Kp的耐药机制以及治疗进展做一综述。

Klebsiella pneumoniae(Kpn)is a common conditional pathogen.Carbapenems have strong antibacterial activity and are highly stable against various types ofβ-lactamase.They are the best antibacterial drugs for treating Kpn infection.However,with the use of carbapenem antibacterials,the carbapenem-resistant Klebsiella pneumoniae(CR-Kp)has a clinically increased isolation rate year by year.The choice of antibiotics for the treatment of infection is very limited,which brings great challenges to clinical treatment.This article reviews the resistance mechanism and treatment progress of CR-Kp from the aspects of carbapenemase production,cell membrane channel protein loss or insufficient quantity.