耐碳青霉烯类肺炎克雷伯菌的流行病学、耐药与传播机制研究进展

摘要

耐碳青霉烯类肺炎克雷伯菌(CRKP),已成为全球公共卫生的严重威胁.长期以来,碳青霉烯类抗生素是治疗肺炎克雷伯菌感染最有效的抗生素,然而其大量使用所带来的选择性压力使得CRKP引起的感染在全球许多地区出现,给临床治疗带来极大挑战.CRKP对碳青霉烯耐药的主要机制是产碳青霉烯酶,常见的类型有KPC、OXA-48和NDM等,产该3类酶的CRKP在全球范围内被报道.CRKP耐药性传播的分子机制是blaKPC、blaOXA-48通过质粒传播,blaNDM通过转座子传播,并在世界范围出现了产两种碳青霉烯酶的CRKP.本文就CRKP流行病学现状,耐药与传播机制研究进展进行综述.%The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious threat to global public health.Carbapenem have been the most effective antibiotic to treat infections caused by Klebsiella pneumoniae for a long time.However,the selective pressure posed by its heavy use results in the emergence of CRKP infection in many parts of the world,bringing great challenges to the clinical treatment.The main mechanism of CRKP resistant to carbapenems is the production of carbapenemases of which the commonly reported types worldwide are KPC,OXA-48 and NDM.The molecular mechanism of CRKP prevalence is the transmission of blaKPC and blaOXA-48 through plasmids and the transmission of blaNDM mediated by transposons.Indeed,CRKP containing two kinds of carbapenemases has emerged worldwide.In this review,we briefly sum up the epidemiological conditions and research progresses of resistance and transmission mechanisms of CRKP.