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产超毒力肺炎克雷伯菌的形成。

The making of hypervirulent Klebsiella pneumoniae.

机构信息

Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, China.

出版信息

J Clin Lab Anal. 2022 Dec;36(12):e24743. doi: 10.1002/jcla.24743. Epub 2022 Nov 8.

Abstract

Klebsiella pneumoniae is a notorious bacterium in clinical practice. Virulence, carbapenem-resistance and their convergence among K. pneumoniae are extensively discussed in this article. Hypervirulent K. pneumoniae (HvKP) has spread from the Asian Pacific Rim to the world, inducing various invasive infections, such as pyogenic liver abscess, endophthalmitis, and meningitis. Furthermore, HvKP has acquired more and more drug resistance. Among multidrug-resistant HvKP, hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP), and carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP) are both devastating for their extreme drug resistance and virulence. The hypervirulence of HvKP is primarily attributed to hypercapsule, macromolecular exopolysaccharides, or excessive siderophores, although it has many other factors, for example, lipopolysaccharides, fimbriae, and porins. In contrast with classical determination of HvKP, that is, animal lethality test, molecular determination could be an optional and practical method after improvement. HvKP, including Hv-CRKP and CR-HvKP, has been progressing. R-M and CRISPR-Cas systems may play pivotal roles in such evolutions. Hv-CRKP and CR-HvKP, in particular the former, should be of severe concern due to their being more and more prevalent.

摘要

肺炎克雷伯菌是临床实践中一种臭名昭著的细菌。本文广泛讨论了肺炎克雷伯菌的毒力、碳青霉烯类耐药性及其两者的趋同现象。高毒力肺炎克雷伯菌(HvKP)已从亚太地区传播到世界各地,引起各种侵袭性感染,如化脓性肝脓肿、眼内炎和脑膜炎。此外,HvKP 获得了越来越多的耐药性。在多药耐药性 HvKP 中,高毒力碳青霉烯类耐药肺炎克雷伯菌(Hv-CRKP)和碳青霉烯类耐药高毒力肺炎克雷伯菌(CR-HvKP)都因其极端的耐药性和毒力而极具破坏性。HvKP 的高毒力主要归因于高荚膜、高分子胞外多糖或过多的铁载体,尽管它还有许多其他因素,例如脂多糖、菌毛和孔蛋白。与经典的 HvKP 确定方法(即动物致死性试验)相比,分子确定在改进后可能是一种可选且实用的方法。HvKP,包括 Hv-CRKP 和 CR-HvKP,一直在进展。R-M 和 CRISPR-Cas 系统在这些进化中可能发挥关键作用。Hv-CRKP 和 CR-HvKP,特别是前者,由于其越来越普遍,应引起严重关注。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f46/9757020/55007566bad3/JCLA-36-e24743-g003.jpg

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