产KPC酶肺炎克雷伯菌异质性耐药研究进展

doi:10.3969/j.issn.1673-8640.2026.08.015

摘要/Abstract

摘要：

肺炎克雷伯菌（KP）是临床常见的条件致病菌，其耐药性问题日益严峻。近年来，产KPC酶KP对碳青霉烯类、黏菌素类、替加环素，以及新型抗菌药物的异质性耐药现象越来越引起关注。异质性耐药是指同一菌群中同时存在对某种抗菌药物耐药和敏感亚群的现象，常规药物敏感性检测易漏检，增加了抗感染治疗失败的风险。产KPC酶KP异质性耐药机制涉及耐药基因多拷贝、bla_kpc突变、外膜蛋白通道突变等多因素协同。目前，临床对该现象认识尚显不足，检测方法和应对策略尚不完善。文章就产KPC酶KP异质性耐药的定义、检测方法、耐药机制和治疗策略进行综述，旨在为临床识别和精准治疗产KPC酶KP异质性耐药提供参考。

关键词: 肺炎克雷伯菌, 异质性耐药, 抗菌药物

Abstract:

Klebsiella pneumoniae（KP） is a common opportunistic pathogen in clinical settings，and its resistance has become increasingly severe. In recent years，heterogeneous resistance of carbapenemase-producing Klebsiella pneumoniae to carbapenems，colistin，tigecycline and even novel antimicrobial agents has drawn growing attention. Heterogeneous resistance refers to the coexistence within a single bacterial population of subpopulations that are resistant and susceptible to a given antibiotic，which is often undetected by conventional drug susceptibility testing，thereby increasing the risk of treatment failure. The mechanisms underlying heterogeneous resistance in carbapenemase-producing Klebsiella pneumoniae involve multiple factors，including multiple copies of resistance genes，mutations in bla_KPC，and alterations in outer membrane protein channels. Currently，clinical awareness of this phenomenon remains limited，and detection methods and management strategies are still inadequate. This review summarizes the definition，detection methods，resistance mechanisms and therapeutic approaches for heterogeneous resistance in 产KPC酶KP，aiming to provide a reference for the clinical identification and precise treatment of such resistance.

Key words: Klebsiella pneumoniae, Heterogeneous resistance, Antimicrobial agent

中图分类号:

R378.99

王艺翔, 侯彦强. 产KPC酶肺炎克雷伯菌异质性耐药研究进展[J]. 检验医学, 2026, 41(8): 811-817.

WANG Yixiang, HOU Yanqiang. Research progress on heterogeneous drug resistance of KPC-producing Klebsiella pneumoniae[J]. Laboratory Medicine, 2026, 41(8): 811-817.

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