耐碳青霉烯类肺炎克雷伯菌对头孢他啶/阿维巴坦耐药的机制及临床治疗进展

Drug resistance mechanism of carbapenem-resistant Klebsiella pneumoniae to ceftazidime/avibactam and progress in clinical treatment

肺炎克雷伯菌是医院获得性感染常见病原菌之一,近年来随着碳青霉烯类的广泛应用,全球各地均出现了耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)。产碳青霉烯酶是肺炎克雷伯菌对碳青霉烯类抗生素耐药的主要原因,超过70%的肺炎克雷伯菌产生碳青霉烯酶。头孢他啶/阿维巴坦(ceftazidime/avibactam,CAZ/AVI)可以有效地治疗CRKP,特别是那些产生肺炎克雷伯菌碳青霉烯酶(Klebsiella pneumoniae carbapenemase,KPC)或苯唑西林酶(oxaclillinase,OXA)-48的CRKP。然而,已有报道CRKP菌株对CAZ/AVI耐药。本文通过对耐CAZ/AVI的CRKP感染流行病学、危险因素、耐药机制等进行总结,为临床CRKP感染用药提供指导。

Klebsiella pneumoniae is one of the common pathogens causing hospital-acquired infection.With the wide use of carbapenem in recent years,carbapenem-resistant Klebsiella pneumoniae(CRKP)has emerged around the world.Carbapenemase production is the main cause of resistance to carbapenem antibiotics in Klebsiella pneumoniae.More than 70%of Klebsiella pneumoniae strains produce carbapenemase.Ceftazidime/avibactam(CAZ/AVI)can effectively treat CRKP infection,especially those caused by CRKP that can produce Klebsiella pneumoniae carbapenemase(KPC)or oxaclillinase(OXA)-48.However,it has been reported that CAZ/AVI-resistant CRKP strains have emerged.In this paper,the epidemiology,risk factors,resistance mechanism and treatment of CAZ/AVI-resistant CRKP were summarized to provide reference for clinical treatment.