肺炎克雷伯氏菌出现高水平抗生素耐药性:叙述性综述

Sona P. H., Pavan Chand Attavar, Rasmi T. R., M. S. Kotian, Delna N. S.
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摘要

在医学取得巨大进步的时代,肺炎克雷伯氏菌持续出现的高水平抗生素耐药性对全球公共卫生构成了严重威胁。随着广泛耐药(XDR)和泛耐药(PDR)肺炎克雷伯菌株在全球范围内的不断扩散,我们的治疗方法即将发生重大转变。包括多种β-内酰胺酶、氨基糖苷修饰酶和染色体突变在内的遗传因素的复杂相互作用,形成了一种动态的耐药机制,可以抵消抗生素的作用。这些错综复杂的适应性既来自质粒的基因转移,也来自基因组本身的变化,给我们管理抗菌药有效性的工作带来了挑战性的障碍。克雷伯氏菌感染在分子策略的武装下卷土重来,给医疗保健系统带来挑战,延长了住院时间,增加了死亡率。在医疗机构之外,随着资源的重新分配,经济和社会方面的影响也在增加,加剧了对弱势群体的影响。本综述深入探讨了肺炎克氏菌对抗生素产生高度耐药性背后的复杂机制,研究了其流行病学、分子和临床方面的问题。综述强调了协调研究、医疗方案和政策的必要性,强调了合理使用抗生素、药物创新和严格感染管理的重要性。
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Emergence of High-Level Antibiotic Resistance in Klebsiella pneumoniae: A Narrative Review
In an era marked by remarkable advancements in medicine, the persistent emergence of high-level antibiotic resistance in Klebsiella pneumoniae poses a critical threat to public health globally. As the worldwide spread of extensively drug-resistant (XDR) and pan-drug-resistant (PDR) K. pneumoniae strains continues to grow, a significant shift in how we approach treatment is on the horizon. The complex interaction of genetic factors, which encompasses a wide range of beta-lactamases, aminoglycoside-modifying enzymes, and chromosomal mutations, creates a dynamic resistance mechanism that counters the effects of antibiotics. These intricate adaptations, arising from both gene transfers facilitated by plasmids and changes in the genome itself, present a challenging obstacle to our efforts in managing antimicrobial effectiveness. Klebsiella infections come back stronger armed with molecular tactics that challenge healthcare systems, prolong hospital stays, and increase mortality. Beyond healthcare settings, the economic and social dimensions grow as resources are redirected, intensifying the impact on vulnerable groups. This review delves into the intricate mechanisms behind the high-level antibiotic resistance in K. pneumoniae, examining its epidemiological, molecular, and clinical facets. Highlighting the necessity for coordinated research, medical protocols, and policies, the review underscores the importance of judicious antibiotic utilization, drug innovation, and rigorous infection management. 
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