2024 年第 8 期 第 0 卷

耐碳青霉烯类肺炎克雷伯菌耐药机制及治疗策略的临床研究进展

Clinical research progress on resistance mechanisms and treatment strategies of carbapenem-resistant Klebsiella pneumoniae

作者：曾妮赵静廖乾莉

英文作者：Zeng Ni Zhao Jing Liao Qianli

单位：四川大学华西医院全科(特需)病房，成都610041

英文单位：General (Special needs) Ward West China Hospital Sichuan University Chengdu 610041 China

关键词：耐碳青霉烯类肺炎克雷伯菌；流行病学；耐药机制；抗菌药物；治疗策略

英文关键词：Carbapenem-resistantKlebsiellapneumoniae;Epidemiology;Drugresistancemechanism; Antimicrobialagents;Treatmentstrategy

• 摘要：

• 近年来，随着碳青霉烯类强效抗菌药物的广泛使用，肺炎克雷伯菌（KP）对碳青霉烯类抗菌药物的耐药率不断上升。耐碳青霉烯类KP（CRKP）目前在全球范围内广泛传播，检出率不断升高，已成为全球重大的公共卫生问题。CRKP耐药机制较为复杂，涉及产碳青霉烯酶、外膜孔蛋白表达异常以及主动外排泵系统过度表达等。对于CRKP菌株导致的感染，临床治疗可选用的抗菌药物有限，感染控制难度大，患者病死率高。因此，临床应积极预防CRKP、早期发现感染并明确耐药机制、优化临床抗菌药物使用和感染防控，寻找新的抗菌药物及新的联合治疗方案以积极应对CRKP。本文综述CRKP感染现状、耐药机制、治疗策略，为CRKP有效防治提供依据。

• In recent years, with the widespread use of carbapenem antibacterial agents, the drug resistance rate of Klebsiella pneumonia (KP) to carbapenem antibacterial agents has been increasing. Carbapenem-resistant KP (CRKP) has been widely spread around the world, and the detection rate is increasing, which has become a major global public health problem. The mechanism of CRKP resistance is complex, involving carbapenemase production, abnormal expression of outer membrane porin, and overexpression of active efflux pump system. For the infection caused by CRKP strains, the clinical treatment of antibiotics is limited, the infection control is difficult, and the patient mortality is high. Therefore, it is necessary to actively prevent CRKP, early detect infection and clarify the mechanism of drug resistance, optimize the clinical use of antibiotics and infection prevention and control, and find new antibiotics and new combination therapy to actively deal with CRKP. This article reviews the current status of CRKP infection, drug resistance mechanisms, and treatment strategies, so as to provide evidence for the effective prevention and treatment of CRKP.