碳青霉烯耐药高毒力肺炎克雷伯菌的研究进展

Research advances of carbapenem-resistant hypervirulent Klebsiella pneumonia

肺炎克雷伯菌是临床常见的条件致病菌。近年来,越来越多的整合高毒力和碳青霉烯耐药表型的临床株,即碳青霉烯耐药的高毒力肺炎克雷伯菌(CR-hvKP)被分离出并导致难以治愈的侵袭性感染,甚至在医院内暴发流行。本文主要针对其流行病学特点及对碳青霉烯类抗生素的耐药机制进行总结。目前ST11-CR-hvKP在我国流行率最高。CR-hvkp主要是通过移动遗传元件如质粒、整合接合元件(ICE)、整合子、插入序列(IS)和转座子在细菌中转移耐药基因和毒力基因。同时CR-hvKP的环境定植以及由此导致的感染和传播风险无疑对感控工作带来巨大挑战。对于碳青霉烯耐药的高毒力肺炎克雷伯菌(CR-hvKP)的临床特点和耐药机制的深入研究有助于寻求可行的方法来根除或阻止菌株的进一步进化和播散。

Klebsiella pneumoniae is a kind of clinical common opportunistic pathogen.In recent years,more and moreclinical strains integrating hypervirulence and carbapenem resistance,i.e.,carbapenem-resistant hypervirulent K.pneumoniae(CR-hvKP)have been isolated and leads to untreatable invasive infections and even fatal transmission.In this paper,the epidemiological characteristics and drug resistance mechanism were summarized.At present ST11-CR-HvKP has the highest prevalence in China.CR-hvkp mainly transfers virulence and resistance genes in Gram-negative pathogensby mobile genetic elements such as plasmids,integrative conjugative elements(ICEs),integrons,insertion sequences(is)and transposons.At the same time,the environmental colonization of CR-hvkp and the resulting risk of infection and transmission undoubtedly pose great challenges to the prevention and control of infection.The in-depth study on the clinical characteristics and drug resistance mechanismof carbapenem-resistant hypervirulent Klebsiella pneumoniae(CR-hvkp)will help us to find feasible methods to eradicate or prevent the further evolution and spread of the strain.