耐碳青霉烯类肺炎克雷伯菌耐药机制及治疗进展

Carbapenem-resistant Klebsiella Pneumoniae Resistance Mechanisms and Therapeutic Advances

经常被发现在人体上呼吸道和肠道的一种条件致病菌,就是肺炎克雷伯菌(KP),是医源性感染菌。随着碳青霉烯类抗生素的过度使用,耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床分离率急速上升。CRKP对碳青霉烯类抗生素有极强的抵抗能力,碳青霉烯类抗生素一直被大家称为“人类抵挡细菌的最后一道防线”。这一类细菌对碳青霉烯类的耐药机制主要包含产碳青霉烯酶、高产Amp C或ESBLS酶合并OMP缺失或表达量不足、主动外排泵及生物膜等因素。近些年耐药病原体的出现和传播,导致抗微生物药物药性日渐衰减,尤其令人担忧的是“超级细菌”在全球快速传播,大大增加了我们的治疗难度。因此该文就CRKP的流行现状、耐药机制及治疗进展进行了综述。

Klebsiella pneumoniae are Gram-negative bacilli often found in the human upper respiratory and intestinal tracts,and are important conditionally pathogenic and medically acquired infections.With the overuse of carbapenem antibiotics,the clinical isolation rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)has increased dramatically.CRKP are highly resistant to carbapenem antibiotics,which have been referred to as the“last line of defense against bacteria”.The resistance mechanism of this group of bacteria to carbapenems mainly involves carbapenemase production,high production of Amp C or ESBLS enzyme combined with OMP deletion or under-expression,active efflux pumps and biofilm,etc.In recent years,carbapenem-resistant pathogens have been recognized as the most effective antibiotics in the world.In recent years,the emergence and spread of drug-resistant pathogens have led to the decreasing efficacy of antimicrobial drugs,and the rapid spread of“superbugs”around the world is particularly worrisome,which greatly increases the difficulty of our treatment.Therefore,this article reviews the drug resistance mechanism and therapeutic progress of CRKP,hoping to provide reference for the prevention,transmission control and treatment of CRKP infection,and to provide a scientific basis for the drug resistance mechanism of CRKP.