Karampatakis Theodoros, Tsergouli Katerina, Behzadi Payam
Department of Clinical Microbiology, University Hospital Kerry, V92 NX94 Tralee, Ireland.
Department of Microbiology, ShQ.C., Islamic Azad University, Shahr-e Qods 37541-374, Iran.
Microorganisms. 2025 Aug 26;13(9):1983. doi: 10.3390/microorganisms13091983.
is a Gram-negative, non-motile pathogen commonly associated with healthcare settings. It is capable of causing severe infections, particularly in immunocompromised and critically ill individuals, and is linked to poor clinical outcomes. Infections caused by carbapenem-resistant (CRAB) represent a major public health concern due to limited treatment options and high resistance rates. Several virulence determinants contribute to CRAB's pathogenicity, including capsular exopolysaccharide (CPS), lipopolysaccharide (LPS), lipooligosaccharide (LOS), efflux pumps, outer membrane proteins (OMPs), pili, metal acquisition systems, two-component regulatory systems (TCSs), and secretion systems (SSs). The dominant resistance mechanism in CRAB involves the production of carbapenemases, most notably oxacillinase-23 (OXA-23) and metallo-β-lactamases (MBLs) such as Verona integron-encoded MBL (VIM) and New Delhi MBL (NDM). Accurate identification of these resistance mechanisms is crucial for guiding effective antimicrobial therapy. Potential treatment options include older agents like polymyxins, ampicillin-sulbactam, high-dose carbapenems, tigecycline, and minocycline, along with newer antimicrobials such as eravacycline, cefiderocol, and aztreonam-avibactam. This review aims to explore the virulence mechanisms and molecular pathogenesis of CRAB, while also presenting recent developments in its epidemiology and available antimicrobial therapies.
是一种革兰氏阴性、无运动性的病原体，通常与医疗环境相关。它能够引起严重感染，尤其是在免疫功能低下和危重症患者中，并与不良临床结局相关。耐碳青霉烯类鲍曼不动杆菌（CRAB）引起的感染由于治疗选择有限和高耐药率而成为主要的公共卫生问题。几种毒力决定因素促成了CRAB的致病性，包括荚膜胞外多糖（CPS）、脂多糖（LPS）、脂寡糖（LOS）、外排泵、外膜蛋白（OMPs）、菌毛、金属获取系统、双组分调节系统（TCSs）和分泌系统（SSs）。CRAB的主要耐药机制涉及碳青霉烯酶的产生，最显著的是氧青霉烷酶-23（OXA-23）和金属β-内酰胺酶（MBLs），如维罗纳整合子编码的MBL（VIM）和新德里MBL（NDM）。准确识别这些耐药机制对于指导有效的抗菌治疗至关重要。潜在的治疗选择包括较老的药物，如多粘菌素、氨苄西林-舒巴坦、高剂量碳青霉烯类、替加环素和米诺环素，以及较新的抗菌药物，如依拉环素、头孢地尔和氨曲南-阿维巴坦。本综述旨在探讨CRAB的毒力机制和分子发病机制，同时介绍其流行病学的最新进展和可用的抗菌治疗方法。
