肺炎克雷伯菌毒力影响因素和耐药机制研究进展
摘要
肺炎克雷伯菌是导致临床感染的常见病原体。高毒力肺炎克雷伯菌株导致的感染具有急性、进展性及全身多部位感染的特点,其毒力影响因素与菌株的荚膜、脂多糖、鞭毛、铁载体及其他外膜蛋白等相关。肺炎克雷伯菌可形成多种耐药机制,包括产β内酰胺酶、外膜蛋白缺失、靶位改变和外排泵等。高毒力肺炎克雷伯菌株一旦获得耐药性,则会给临床治疗带来困难。本文对其毒力影响因素和耐药机制进行综述。
引文
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[2] Fang CT, Lai SY, Yi WC, et al. Klebsiella pneumoniae genotype K1:an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess[J]. Clin Infect Dis,2007, 45:284-293.
[3] Yoshida K, Matsumoto T, Tateda K, et al. Role of bacterial capsule in local and systemic inflammatory responses of mice during pulmonary infection with Klebsiella pneumoniae[J]. J Med Microbiol, 2000, 49:1003-1010.
[4] Fang CT, Chuang YP, Shun CT, et al. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications[J]. J Exp Med, 2004, 199:697-705.
[5] Llobet E, Campos MA, Giménez P, et al. Analysis of the networks controlling the antimicrobial-peptide-dependent induction of Klebsiella pneumoniae virulence factors[J]. Infect Immun, 2011, 79:3718-3732.
[6] Alvarez D, Merino S, Tomás JM, et al. Capsular polysaccharide is a major complement resistance factor in lipopolysaccharide O side chain-deficient Klebsiella pneumoniae clinical isolates[J]. Infect Immun, 2000, 68:953-955.
[7] Regueiro V, Moranta D, Frank CG, et al. Klebsiella pneumoniae subverts the activation of inflammatory responses in a NOD1-dependent manner[J]. Cell Microbiol, 2011, 13:135-153.
[8] Pan YJ, Fang HC, Yang HC, et al. Capsular polysaccharide synthesis regions in Klebsiella pneumoniae serotype K57 and a new capsular serotype[J]. J Clin Microbiol, 2008, 46:2231-2240.
[9] Fung CP, Chang FY, Lee SC, et al. A global emerging disease of Klebsiella pneumoniae liver abscess:is serotype K1 an important factor for complicated endophthalmitis?[J]. Gut, 2002, 50:420-424.
[10] Shu HY, Fung CP, Liu YM, et al. Genetic diversity of capsular polysaccharide biosynthesis in Klebsiella pneumoniae clinical isolates[J].Microbiology, 2009, 155:4170-4183.
[11] Hsu CR, Lin TL, Chen YC, et al. The role of Klebsiella pneumoniae rmpA in capsular polysaccharide synthesis and virulence revisited[J].Microbiology, 2011, 157:3446-3457.
[12] Fang CT, Lai SY, Yi WC, et al. The function of wzy_K1(magA),the serotype K1 polymerase gene in Klebsiella pneumoniae cps gene cluster[J]. J Infect Dis, 2010, 201:1268-1269.
[13] Wu JH, Wu AM, Tsai CG, et al. Contribution of fucose-containing capsules in Klebsiella pneumoniae to bacterial virulence in mice[J].Exp Biol Med(Maywood), 2008, 233:64-70.
[14] Merino S, Camprubi S, Alberti S, et al. Mechanisms of Klebsiella pneumoniae resistance to complement-mediated killing[J]. Infect Immun, 1992, 60:2529-2535.
[15] ReguéM, Hita B, PiquéN, et al. A gene,uge,is essential for Klebsiella pneumoniae virulence[J]. Infect Immun, 2004, 72:54-61.
[16] Jung SG, Jang JH, Kim AY, et al. Removal of pathogenic factors from2,3-butanediol-producing Klebsiella species by inactivating virulence-related wabG gene[J]. Appl Microbiol Biotechnol, 2013, 97:1997-2007.
[17] Ganz T. Iron and infection[J]. Int J Hematol, 2018, 107:7-15.
[18] Miethke M, Marahiel MA. Siderophore-based iron acquisition and pathogen control[J]. Microbiol Mol Biol Rev, 2007, 71:413-451.
[19] Hsieh PF, Lin TL, Lee CZ, et al. Serum-induced iron-acquisition systems and TonB contribute to virulence in Klebsiella pneumoniae causing primary pyogenic liver abscess[J]. J Infect Dis, 2008, 197:1717-1727.
[20] Bach S, de Almeida A, Carniel E. The Yersinia high-pathogenicity island is present in different members of the family Enterobacteriaceae[J]. FEMS Microbiol Lett, 2000, 183:289-294.
[21] Russo TA, Olson R, MacDonald U, et al. Aerobactin,but not yersiniabactin,salmochelin,or enterobactin,enables the growth/survival of hypervirulent(hypermucoviscous)Klebsiella pneumoniae ex vivo and in vivo[J]. Infect Immun, 2015, 83:3325-3333.
[22] Struve C, Bojer M, Krogfelt KA. Identification of a conserved chromosomal region encoding Klebsiella pneumoniae type 1 and type 3 fimbriae and assessment of the role of fimbriae in pathogenicity[J]. Infect Immun, 2009, 77:5016-5024.
[23] Ramirez P, Bassi GL, Torres A. Measures to prevent nosocomial infections during mechanical ventilation[J]. Curr Opin Crit Care, 2012, 18:86-92.
[24] Shaikh S, Rizvi S, Anis R, et al. Prevalence of CTX-M resistance marker and integrons among Escherichia coli and klebsiella pneumoniae isolates of clinical origin[J]. Lett Appl Microbiol, 2016, 62:419-427.
[25] Munoz-Price LS, Quinn JP. The spread of klebsiella pneumoniae carbapenemases:a tale of strains,plasmids,and transposons[J]. Clin Infect Dis, 2009, 49:1739-1741.
[26] Johnson AP, Woodford N. Global spread of antibiotic resistance:the example of New Delhi metallo-beta-lactamase(NDM)-mediated carbapenem resistance[J]. J Med Microbiol, 2013, 62:499-513.
[27] Bialek-Davenet S, Lavigne JP, Guyot K, et al. Differential contribution of AcrAB and OqxAB efflux pumps to multidrug resistance and virulence in klebsiella pneumonia[J]. J Antimicrob Chemother, 2015,70:81-88.