Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria.
Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria.
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DOI：
10.1097/smj.0b013e3181fd7d5a
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发表时间：
2011-01
影响因子：
1.1
通讯作者：
Morgan DJ
中科院分区：
文献类型：
--
作者：
Arnold RS;Thom KA;Sharma S;Phillips M;Kristie Johnson J;Morgan DJ
产碳青霉烯酶肺炎克雷伯菌（KPC）的细菌是一组新兴的高度耐药革兰氏阴性杆菌，可引起与显著发病率和死亡率相关的感染。一旦局限于美国东北部的爆发，它们已经蔓延到整个美国和世界大部分地区。KPC是越来越广泛的革兰氏阴性菌的重要耐药机制，不再局限于肺炎克雷伯菌。产KPC的细菌经常被常规微生物敏感性测试错误识别，并被错误地报告为对碳青霉烯类敏感;然而，对碳青霉烯类抗生素厄他培南的耐药性很常见，并且是KPC存在的更好指标。碳青霉烯类抗生素通常对产生KPC的微生物无效。对产生KPC的微生物的最佳治疗方法尚未确定;然而，基于体外药敏试验的常见治疗方法是多粘菌素类、替加环素类和较少使用的氨基糖苷类抗生素。本综述的目的是确定产生KPC的细菌给临床医生带来的各种挑战。这些问题包括需要特殊的微生物检测技术，医院传播的可能性，以及与有限的、相对未经证实的抗菌治疗方案相关的治疗挑战。
Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are a group of emerging highly drug-resistant Gram-negative bacilli causing infections associated with significant morbidity and mortality. Once confined to outbreaks in the northeastern United States (US), they have spread throughout the US and most of the world. KPCs are an important mechanism of resistance for an increasingly wide range of Gram-negative bacteria and are no longer limited to K pneumoniae. KPC-producing bacteria are often misidentified by routine microbiological susceptibility testing and incorrectly reported as sensitive to carbapenems; however, resistance to the carbapenem antibiotic ertapenem is common and a better indicator of the presence of KPCs. Carbapenem antibiotics are generally not effective against KPC-producing organisms. The best therapeutic approach to KPC-producing organisms has yet to be defined; however, common treatments based on in vitro susceptibility testing are the polymyxins, tigecycline, and less frequently aminoglycoside antibiotics. The purpose of this review is to identify the various challenges that KPC-producing bacteria present to clinicians. These include the need for special techniques for microbiological detection, the potential for nosocomial transmission, and therapeutic challenges related to limited, relatively unproven antimicrobial treatment options.