耐碳青霉烯类肺炎克雷伯菌的耐药机制及其分子检测

Drug-resistant mechanism of carbapenem-resistant Klebsiella pneumoniae and its molecular detection

肺炎克雷伯菌是引起社区获得性感染和医院感染的重要病原体,碳青霉烯类抗生素是目前治疗肺炎克雷伯菌严重感染的重要抗菌药物,而耐碳青霉烯类肺炎克雷伯菌(CR-KP)分离率逐年提升,标志着耐碳青霉烯类肺炎克雷伯菌的耐药情况愈加严峻。耐碳青霉烯类肺炎克雷伯菌可以通过β-内酰胺酶的生成、孔蛋白的改变和外排泵活性的增加导致碳青霉烯的耐药。目前分子检测方法有聚合酶链反应(PCR)类、基质辅助激光解吸电离-飞行时间质谱(MALDI-TOF MS)、下一代测序及环介导等温扩增(LAMP)技术,但部分尚未应用于临床。了解耐碳青霉烯类肺炎克雷伯菌的耐药机制,改进检测方法是非常重要的。

Klebsiella pneumoniae is an important pathogen causing community-acquired and nosocomial infections.Carbapenems are important antibiotics in the treatment of Klebsiella pneumoniae severe infection,and the isolation rate of carbapenem-resistant Klebsiella pneumoniae(CR-KP)is increasing year by year,which indicates that the antibiotics resistance of CR-KP is becoming more and more serious.CR-KP can lead to carbapenem resistance through the production ofβ-lactamase,the change of porin and the increase of efflux pump activity.At present,the molecular detection methods include polymerase chain reaction(PCR),matrix-assisted laser desorption ionization-time-of-flight mass spectrometry(MALDI-TOF MS),next generation sequencing and loop-mediated isothermal amplification(LAMP)technology,but some of them have not been used in clinical practice.It is essential to understand the drug-resistant mechanism of CR-KP and to improve the detection method.