摘要

肺炎克雷伯菌是影响人类的重要的多重耐药（MDR）病原体，并且是由于有限的治疗选择导致的与高发病率和死亡率相关的医院感染的主要来源。我们总结了这种病原体的广泛抗性，其中包括丰富的染色体和质粒编码的抗生素抗性基因（ARG）。在抗生素选择压力下，肺炎克雷伯菌通过从头突变，通过获得质粒和可转移的遗传元件，不断积累ARGs，导致极度耐药（XDR）菌株携带“超级抗体”。在过去的二十年中，许多高风险（HiR）耐多药和XDR肺炎克雷伯菌序列类型出现，显示出引起多重暴发的优越能力，以及持续的全球传播。这些数据突出了MDR和XDR肺炎克雷伯菌的复杂演变，涉及ARGs的转移和传播，以及流行质粒在高度传播成功克隆中的作用。随着抗生素耐药性的全球性灾难和迫切需要确定对传染病的未来构成威胁的主要病原体，进一步的研究有助于确定肺炎克雷伯菌的流行特征和质粒获取。未来的基因组和翻译研究需要破译HiR克隆中的特定靶点以设计有针对性的预防和治疗。

Klebsiella pneumoniae is an important multidrug-resistant (MDR) pathogen affecting humans and a major source for hospital infections associated with high morbidity and mortality due to limited treatment options. We summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmid-encoded antibiotic resistance genes (ARGs). Under antibiotic selective pressure, K. pneumoniae continuously accumulates ARGs, byde novo mutations, and via acquisition of plasmids and transferable genetic elements, leading to extremely drug resistant (XDR) strains harboring a ‘super resistome’. In the last two decades, numerous high-risk (HiR) MDR and XDR K. pneumoniae sequence types have emerged showing superior ability to cause multicontinent outbreaks, and continuous global dissemination. The data highlight the complex evolution of MDR and XDR K. pneumoniae, involving transfer and spread of ARGs, and epidemic plasmids in highly disseminating successful clones. With the worldwide catastrophe of antibiotic resistance and the urgent need to identify the main pathogens that pose a threat on the future of infectious diseases, further studies are warranted to determine the epidemic traits and plasmid acquisition in K. pneumoniae. There is a need for future genomic and translational studies to decipher specific targets in HiR clones to design targeted prevention and treatment.

https://academic.oup.com/femsre/article-abstract/41/3/252/3830265