Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy.
Clin Microbiol Infect. 2018 Feb;24(2):133-144. doi: 10.1016/j.cmi.2017.08.030. Epub 2017 Sep 9.
Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas.
To provide practical suggestion for physicians dealing with the management of KPC-KP infections in critically ill patients, based on expert opinions.
PubMed search for relevant publications related to the management of KPC-KP infections.
A panel of experts developed a list of 12 questions to be addressed. In view of the current lack of high-level evidence, they were asked to provide answers on the bases of their knowledge and experience in the field. The panel identified several key aspects to be addressed when dealing with KPC-KP in critically ill patients (preventing colonization in the patient, preventing infection in the colonized patient and colonization of his or her contacts, reducing mortality in the infected patient by rapidly diagnosing the causative agent and promptly adopting the best therapeutic strategy) and provided related suggestions that were based on the available observational literature and the experience of panel members.
Diagnostic technologies could speed up the diagnosis of KPC-KP infections. Combination treatment should be preferred to monotherapy in cases of severe infections. For non-critically ill patients without severe infections, results from randomized clinical trials are needed for ultimately weighing benefits and costs of using combinations rather than monotherapy. Multifaceted infection control interventions are needed to decrease the rates of colonization and cross-transmission of KPC-KP.
产碳青霉烯酶肺炎克雷伯菌（KPC）导致的肺炎克雷伯菌（KPC-KP）已成为最重要的当代病原体之一，尤其是在流行地区。
根据专家意见，为处理危重症患者产 KPC-KP 感染的医生提供实用建议。
针对与产 KPC-KP 感染的管理相关的文献，在 PubMed 上进行检索。
一组专家制定了一个需要回答的 12 个问题列表。鉴于目前缺乏高级别证据，他们被要求根据自己在该领域的知识和经验来回答问题。专家组确定了在处理危重症患者产 KPC-KP 感染时需要解决的几个关键方面（防止患者定植、防止定植患者发生感染以及其接触者的定植、通过快速诊断病原体和及时采用最佳治疗策略降低感染患者的死亡率），并根据现有的观察性文献和专家组成员的经验提供了相关建议。
诊断技术可以加快产 KPC-KP 感染的诊断。在严重感染的情况下，应优先选择联合治疗而非单药治疗。对于无严重感染的非危重症患者，需要随机临床试验的结果，最终权衡使用联合治疗而非单药治疗的获益和成本。需要采取多方面的感染控制干预措施，以降低 KPC-KP 的定植和交叉传播率。
