Clinical Implications of Genomic Adaptation and Evolution of Carbapenem-Resistant Klebsiella pneumoniae
Clinical Implications of Genomic Adaptation and Evolution of Carbapenem-Resistant Klebsiella pneumoniae
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DOI：
10.1093/infdis/jiw378
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发表时间：
2017-02-15
影响因子：
6.4
通讯作者：
Uhlemann, Anne-Catrin
中科院分区：
文献类型：
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作者：
Gomez-Simmonds, Angela;Uhlemann, Anne-Catrin
肺炎克雷伯氏菌作为多重耐药感染的重要原因，对全球医疗保健构成了重大挑战。包括流行性序列类型258（ST 258）在内的医院内克隆已显示出获得和传播抗性质粒，特别是K.肺炎碳青霉烯酶。相比之下，严重的社区相关K。肺炎感染导致了对属于K1和K2荚膜血清型的高毒力菌株的认识增加，主要在东亚。基因组和功能研究表明，各种毒力和免疫逃避因素有助于医院和社区相关的克隆谱系的成功，通过遗传可塑性机制，有助于吸收与抗菌药物耐药性和致病性相关的基因。虽然目前似乎有有限的重叠之间的抗性和超毒力谱系，特定的细菌和宿主因素的出现，占主导地位的克隆仍然不完全了解。本文综述了克雷伯氏菌的分子流行病学、毒力潜力和宿主-病原体相互作用等方面的研究进展。肺炎。
Klebsiella pneumoniae poses a major challenge to healthcare worldwide as an important cause of multidrug-resistant infections. Nosocomial clones, including epidemic sequence type 258 (ST258), have shown an affinity for acquiring and disseminating resistance plasmids, particularly variants of the K. pneumoniae carbapenemase. By comparison, the resurgence of severe community-associated K. pneumoniae infections has led to increased recognition of hypervirulent strains belonging to the K1 and K2 capsular serotypes, predominantly in eastern Asia. Genomic and functional studies suggest that a variety of virulence and immune evasive factors contribute to the success of nosocomial and community-associated clonal lineages, aided by mechanisms of genetic plasticity that contribute to uptake of genes associated with antimicrobial resistance and pathogenicity. While there currently appears to be limited overlap between resistant and hypervirulent lineages, specific bacterial and host factors contributing to the emergence of dominant clones remain incompletely understood. This review summarizes recent advances in our understanding of the molecular epidemiology, virulence potential, and host-pathogen interactions of K. pneumoniae.