Klebsiella pneumoniae carbapenemase variants: the new threat to global public health.

IF 19 1区 医学 Q1 MICROBIOLOGY Clinical Microbiology Reviews Pub Date : 2023-12-20 Epub Date: 2023-11-08 DOI:10.1128/cmr.00008-23
Li Ding, Siquan Shen, Jing Chen, Zhen Tian, Qingyu Shi, Renru Han, Yan Guo, Fupin Hu
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Abstract

Klebsiella pneumoniae carbapenemase (KPC) variants, which refer to the substitution, insertion, or deletion of amino acid sequence compared to wild blaKPC type, have reduced utility of ceftazidime-avibactam (CZA), a pioneer antimicrobial agent in treating carbapenem-resistant Enterobacterales infections. So far, more than 150 blaKPC variants have been reported worldwide, and most of the new variants were discovered in the past 3 years, which calls for public alarm. The KPC variant protein enhances the affinity to ceftazidime and weakens the affinity to avibactam by changing the KPC structure, thereby mediating bacterial resistance to CZA. At present, there are still no guidelines or expert consensus to make recommendations for the diagnosis and treatment of infections caused by KPC variants. In addition, meropenem-vaborbactam, imipenem-relebactam, and other new β-lactam-β-lactamase inhibitor combinations have little discussion on KPC variants. This review aims to discuss the clinical characteristics, risk factors, epidemiological characteristics, antimicrobial susceptibility profiles, methods for detecting blaKPC variants, treatment options, and future perspectives of blaKPC variants worldwide to alert this new great public health threat.

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肺炎克雷伯菌碳青霉烯酶变体:对全球公共健康的新威胁。
SUMMARYKlebsiella pneumoniae碳青霉烯酶(KPC)变体是指与野生blaKPC型相比氨基酸序列的取代、插入或缺失,它降低了头孢他啶-阿维巴坦(CZA)的效用,头孢他啶是治疗碳青霉烯耐药性肠杆菌感染的先锋抗菌剂。到目前为止,全球已报告了150多种blaKPC变体,其中大多数新变体是在过去3年中发现的,这需要公众警惕。KPC变体蛋白通过改变KPC结构来增强对头孢他啶的亲和力,并削弱对阿维巴坦的亲和力,从而介导细菌对CZA的耐药性。目前,仍然没有指导方针或专家共识来就KPC变异株引起的感染的诊断和治疗提出建议。此外,美罗培南-沃博巴坦、亚胺培南-雷巴坦和其他新的β-内酰胺酶抑制剂组合对KPC变体的讨论很少。这篇综述旨在讨论世界范围内blaKPC变异株的临床特征、危险因素、流行病学特征、抗菌药物敏感性、检测方法、治疗选择和未来前景,以提醒人们注意这一新的巨大公共卫生威胁。
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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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