Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods.
Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods.
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DOI：
10.3389/fmicb.2016.00895
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发表时间：
2016
影响因子：
5.2
通讯作者：
Lee SH
中科院分区：
文献类型：
--
作者：
Lee CR;Lee JH;Park KS;Kim YB;Jeong BC;Lee SH
耐碳青霉烯类革兰氏阴性病原体的出现对全球公共卫生构成严重威胁。特别是，碳青霉烯类耐药肺炎克雷伯菌的流行率日益增加是一个主要问题。K.肺炎碳青霉烯酶（KPC）和苯唑西林酶-48（OXA-48）型碳青霉烯酶已在世界范围内报道。新德里金属-β-内酰胺酶（NDM）碳青霉烯酶最初于2008年在瑞典发现，并在全球迅速传播。本文就克雷伯氏菌的流行病学进行综述。肺炎杆菌产生三种碳青霉烯酶（KPC、NDM和OXA-48样）。虽然每种耐药菌株的流行率在地理上各不相同，但K。产生KPC、NDM和OXA-48样碳青霉烯酶的肺炎链球菌已迅速播散。此外，我们利用最近发表的分子和遗传学研究来分析这三种碳青霉烯酶和主要的K。肺炎克雷伯氏菌克隆，如ST 258和ST 11，已成为全球流行。因为产碳青霉烯酶的K.肺炎链球菌通常对大多数β-内酰胺抗生素和许多其它非β-内酰胺分子具有抗性，但可用于治疗这些菌株感染的治疗选择限于粘菌素、多粘菌素B、磷霉素、替加环素和选定的氨基糖苷类。尽管如此，建议联合治疗用于治疗严重产碳青霉烯酶的克雷伯菌。肺炎感染，该策略的临床证据目前有限，需要更准确的随机对照试验来建立最有效的治疗方案。此外，由于快速和准确地鉴定在克雷伯菌中发现的碳青霉烯酶类型，肺炎可能难以通过表型抗生素敏感性测试实现，目前正在开发新的分子检测技术。
The emergence of carbapenem-resistant Gram-negative pathogens poses a serious threat to public health worldwide. In particular, the increasing prevalence of carbapenem-resistant Klebsiella pneumoniae is a major source of concern. K. pneumoniae carbapenemases (KPCs) and carbapenemases of the oxacillinase-48 (OXA-48) type have been reported worldwide. New Delhi metallo-β-lactamase (NDM) carbapenemases were originally identified in Sweden in 2008 and have spread worldwide rapidly. In this review, we summarize the epidemiology of K. pneumoniae producing three carbapenemases (KPCs, NDMs, and OXA-48-like). Although the prevalence of each resistant strain varies geographically, K. pneumoniae producing KPCs, NDMs, and OXA-48-like carbapenemases have become rapidly disseminated. In addition, we used recently published molecular and genetic studies to analyze the mechanisms by which these three carbapenemases, and major K. pneumoniae clones, such as ST258 and ST11, have become globally prevalent. Because carbapenemase-producing K. pneumoniae are often resistant to most β-lactam antibiotics and many other non-β-lactam molecules, the therapeutic options available to treat infection with these strains are limited to colistin, polymyxin B, fosfomycin, tigecycline, and selected aminoglycosides. Although, combination therapy has been recommended for the treatment of severe carbapenemase-producing K. pneumoniae infections, the clinical evidence for this strategy is currently limited, and more accurate randomized controlled trials will be required to establish the most effective treatment regimen. Moreover, because rapid and accurate identification of the carbapenemase type found in K. pneumoniae may be difficult to achieve through phenotypic antibiotic susceptibility tests, novel molecular detection techniques are currently being developed.
影响因子：
6.7
作者：
Lee JH;Jeong SH;Cha SS;Lee SH
通讯作者：
Lee SH