Colonization, Infection, and the Accessory Genome of Klebsiella pneumoniae.
Colonization, Infection, and the Accessory Genome of Klebsiella pneumoniae.
复制标题
肺炎克雷伯氏菌的殖民化，感染和辅助基因组。
DOI：
10.3389/fcimb.2018.00004
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发表时间：
2018
影响因子：
5.7
通讯作者：
Bachman MA
中科院分区：
文献类型：
--
作者：
Martin RM;Bachman MA
肺炎克雷伯菌是一种革兰氏阴性病原体，具有大量质粒辅助基因组和染色体基因位点。该辅助基因组将肺炎克雷伯菌菌株分为机会性菌株、高毒力菌株和多重耐药菌株，并将肺炎克雷伯菌与两个密切相关的物种（水痘克雷伯氏菌和准肺炎克雷伯氏菌）分开。肺炎克雷伯菌的某些菌株作为机会病原体，感染危重患者和免疫功能低下的患者。这些肺炎克雷伯菌是医疗保健相关感染的常见原因，包括肺炎、尿路感染 (UTI) 和血流感染。水痘克雷伯菌和准肺炎克雷伯菌在临床上通常无法与机会性肺炎克雷伯菌区分。肺炎克雷伯菌的其他菌株毒性很强，可感染社区环境中的健康人群并引起严重感染，包括化脓性肝脓肿、眼内炎和脑膜炎。第三组肺炎克雷伯菌编码碳青霉烯酶，使其对抗生素具有高度耐药性。这些菌株充当机会主义者，但极其难以治疗。所有这些肺炎克雷伯菌和相关物种都可以在胃肠道定植，并且辅助基因组可以确定定植菌株是否保持无症状或进展导致疾病。本综述将探讨机会性、抗生素耐药性和高毒力肺炎克雷伯菌菌株定植与感染之间的关联，以及辅助基因组在区分这些群体和相关物种中的作用。由于面对抗生素耐药性和高毒力菌株，肺炎克雷伯菌感染变得越来越难以治疗，因此加深对这些细菌的流行病学和发病机制的了解至关重要。
Klebsiella pneumoniae is a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome divides K. pneumoniae strains into opportunistic, hypervirulent, and multidrug-resistant groups and separates K. pneumoniae from two closely related species, Klebsiella variicola and Klebsiella quasipneumoniae. Some strains of K. pneumoniae act as opportunistic pathogens, infecting critically ill and immunocompromised patients. These K. pneumoniae are a common cause of health-care associated infections including pneumonia, urinary tract infections (UTIs), and bloodstream infections. K. variicola and K. quasipneumoniae are often clinically indistinguishable from opportunistic K. pneumoniae. Other strains of K. pneumoniae are hypervirulent, infecting healthy people in community settings and causing severe infections including pyogenic liver abscess, endophthalmitis, and meningitis. A third group of K. pneumoniae encode carbapenemases, making them highly antibiotic-resistant. These strains act as opportunists but are exceedingly difficult to treat. All of these groups of K. pneumoniae and related species can colonize the gastrointestinal tract, and the accessory genome may determine if a colonizing strain remains asymptomatic or progresses to cause disease. This review will explore the associations between colonization and infection with opportunistic, antibiotic-resistant, and hypervirulent K. pneumoniae strains and the role of the accessory genome in distinguishing these groups and related species. As K. pneumoniae infections become progressively more difficult to treat in the face of antibiotic resistance and hypervirulent strains, an increased understanding of the epidemiology and pathogenesis of these bacteria is vital.