Gomez-Simmonds Angela, Uhlemann Anne-Catrin
Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York.
J Infect Dis. 2017 Feb 15;215(suppl_1):S18-S27. doi: 10.1093/infdis/jiw378.
Klebsiella pneumoniae poses a major challenge to healthcare worldwide as an important cause of multidrug-resistant infections. Nosocomial clones, including epidemic sequence type 258 (ST258), have shown an affinity for acquiring and disseminating resistance plasmids, particularly variants of the K. pneumoniae carbapenemase. By comparison, the resurgence of severe community-associated K. pneumoniae infections has led to increased recognition of hypervirulent strains belonging to the K1 and K2 capsular serotypes, predominantly in eastern Asia. Genomic and functional studies suggest that a variety of virulence and immune evasive factors contribute to the success of nosocomial and community-associated clonal lineages, aided by mechanisms of genetic plasticity that contribute to uptake of genes associated with antimicrobial resistance and pathogenicity. While there currently appears to be limited overlap between resistant and hypervirulent lineages, specific bacterial and host factors contributing to the emergence of dominant clones remain incompletely understood. This review summarizes recent advances in our understanding of the molecular epidemiology, virulence potential, and host-pathogen interactions of K. pneumoniae.
肺炎克雷伯菌作为耐多药感染的重要病因，给全球医疗保健带来了重大挑战。包括流行序列型258（ST258）在内的医院内克隆株已显示出获取和传播耐药质粒的倾向，尤其是肺炎克雷伯菌碳青霉烯酶的变体。相比之下，严重社区获得性肺炎克雷伯菌感染的复发导致人们对主要在东亚地区出现的、属于K1和K2荚膜血清型的高毒力菌株的认识有所增加。基因组和功能研究表明，多种毒力和免疫逃避因子有助于医院内和社区获得性克隆谱系的成功，这得益于遗传可塑性机制，该机制有助于摄取与抗菌耐药性和致病性相关的基因。虽然目前耐药谱系和高毒力谱系之间的重叠似乎有限，但导致优势克隆出现的特定细菌和宿主因素仍未完全明了。本综述总结了我们在理解肺炎克雷伯菌的分子流行病学、毒力潜力和宿主-病原体相互作用方面的最新进展。
