Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.
Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.
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DOI：
10.1016/s1473-3099(13)70190-7
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发表时间：
2013-09
期刊：
影响因子：
--
通讯作者：
Quinn JP
中科院分区：
文献类型：
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作者：
Munoz-Price LS;Poirel L;Bonomo RA;Schwaber MJ;Daikos GL;Cormican M;Cornaglia G;Garau J;Gniadkowski M;Hayden MK;Kumarasamy K;Livermore DM;Maya JJ;Nordmann P;Patel JB;Paterson DL;Pitout J;Villegas MV;Wang H;Woodford N;Quinn JP
肺炎克雷伯菌碳青霉烯酶（KPC）最初于1996年在美国发现。从那时起，这些多功能β-内酰胺酶在革兰氏阴性菌中传播，特别是肺炎克雷伯菌，尽管它们的精确流行病学在不同国家和地区存在差异。感染KPC阳性微生物的患者的死亡率较高，可能是由于剩余的抗生素选择有限（通常为粘菌素、替加环素或氨基糖苷类）。最近，使用粘菌素、替加环素和亚胺培南的三联药物组合与改善菌血症患者的生存率相关。在这篇综述中，我们总结了各大洲KPC的流行病学，并讨论了检测问题，目前的抗生素选择和开发中的抗生素选择，治疗结果和死亡率以及感染控制。鉴于目前治疗方法的局限性和缺乏正在研制中的新药，感染控制必须是我们目前的主要防御措施。
Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile β-lactamases have spread internationally among Gram-negative bacteria, especially K pneumoniae, although their precise epidemiology is diverse across countries and regions. The mortality described among patients infected with organisms positive for KPC is high, perhaps as a result of the limited antibiotic options remaining (often colistin, tigecycline, or aminoglycosides). Triple drug combinations using colistin, tigecycline, and imipenem have recently been associated with improved survival among patients with bacteraemia. In this Review, we summarise the epidemiology of KPCs across continents, and discuss issues around detection, present antibiotic options and those in development, treatment outcome and mortality, and infection control. In view of the limitations of present treatments and the paucity of new drugs in the pipeline, infection control must be our primary defence for now.