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