肺炎克雷伯菌毒力特征与耐药性的研究进展
Advances in Virulence Characterization and Drug Resistance of Klebsiella Pneumoniae
DOI: 10.12677/md.2025.155065, PDF,    科研立项经费支持
作者: 杨程帆, 史 简, 李 雪：济宁医学院临床医学院，山东 济宁；王 杰, 韩 亮, 刘 燕, 陆书华*：济宁医学院附属医院医学检验科，山东 济宁
关键词: 肺炎克雷伯菌；高毒力；多重耐药；耐药机制；Klebsiella Pneumoniae； High Virulence； Multi-Drug Resistance； Resistance Mechanisms
摘要: 肺炎克雷伯菌是引起社区获得性感染和医院感染的重要病原体，可引起肺部、血流、泌尿系统、中枢神经系统等全身多部位的感染。由于抗生素的不合理使用等原因，肺炎克雷伯菌呈现高毒力及多重耐药的表现，严重影响患者的治疗及预后，给临床诊疗带来严峻的挑战。本文就肺炎克雷伯菌的毒力特征与耐药性的研究进展进行综述。为临床医生的抗感染治疗和医院感染防控策略提供精准有效的理论依据。
Abstract: Klebsiella pneumoniae is an important pathogen causing community-acquired infections and hospital-acquired infections, which can lead to infections in multiple parts of the body, such as the lungs, the bloodstream, the urinary system, and the central nervous system. Due to the irrational use of antibiotics, Klebsiella pneumoniae shows high virulence and multi-drug resistance, which seriously affects the treatment and prognosis of patients, and poses a serious challenge to clinical diagnosis and treatment. In this paper, the research progress of virulence characteristics and drug resistance of Klebsiella pneumoniae is reviewed. It provides precise and effective theoretical basis for clinicians’ anti-infective treatment and hospital infection prevention and control strategies.
文章引用：杨程帆, 史简, 王杰, 韩亮, 刘燕, 李雪, 陆书华. 肺炎克雷伯菌毒力特征与耐药性的研究进展[J]. 医学诊断, 2025, 15(5): 478-486. https://doi.org/10.12677/md.2025.155065

参考文献

[1] 张雅婷, 赵改婵, 专行, 等. 湖北省肺炎克雷伯菌耐药性及高毒力荚膜血清分型研究[J]. 国际检验医学杂志, 2022, 43(22): 2750-2754.
[2] 侯玲燕, 伊茂礼. 高毒力肺炎克雷伯菌研究进展[J]. 医学检验与临床, 2023, 34(7): 43-47.
[3] Li, L., Ma, J., Cheng, P., Li, M., Yu, Z., Song, X., et al. (2023) Roles of Two-Component Regulatory Systems in Klebsiella pneumoniae: Regulation of Virulence, Antibiotic Resistance, and Stress Responses. Microbiological Research, 272, Article ID: 127374. [Google Scholar] [CrossRef] [PubMed]
[4] 刘义思, 高燕. 高毒力肺炎克雷伯菌肝脓肿临床研究进展[J]. 中国感染与化疗杂志, 2020, 20(1): 95-101.
[5] 朱晓红, 梁栋. 肝脓肿并发脓毒血症的临床特点及其危险因素[J]. 肝脏, 2025, 30(7): 975-978, 982.
[6] 柴旭瑞, 赵娜, 周翠红. 耐碳青霉烯类肺炎克雷伯菌的临床分布特征和耐药性分析[J]. 航空航天医学杂志, 2025, 36(8): 956-958.
[7] Zhang, Y., Wang, Q., Yin, Y., Chen, H., Jin, L., Gu, B., et al. (2018) Epidemiology of Carbapenem-Resistant Enterobacteriaceae Infections: Report from the China CRE Network. Antimicrobial Agents and Chemotherapy, 62, e01882-17. [Google Scholar] [CrossRef] [PubMed]
[8] CHINETS. 中国细菌耐药监测网. 肺炎克雷伯菌对亚胺培南和美罗培南的耐药变迁[EB/OL].
http://www.chinets.com/Data/GermYear, 2022-02-11.
[9] 毕菁, 陈雯杰, 田靓, 等. 上海市医疗机构ST11型耐碳青霉烯类肺炎克雷伯菌分子流行病学特征与高毒力进化研究[J]. 中国感染控制杂志, 2025, 24(8): 1075-1082.
[10] 任美迪, 陈丝丝, 刘君. 高毒力肺炎克雷伯菌的流行病学和毒力进化及其耐药性研究进展[J]. 中华医院感染学杂志, 2025(19): 3020-3024.
[11] 张海洋, 韩晶, 王中天, 等. 高毒力肺炎克雷伯菌致病、耐药机制及其治疗研究进展[J]. 中国病原生物学杂志, 2024, 19(10): 1239-1243, 1247.
[12] 幸运, 袁其米, 覃晓宇, 等. 高毒力肺炎克雷伯菌的临床特征及分子流行病学研究[J]. 国际检验医学杂志, 2023, 44(16): 1979-1983.
[13] 孔娜娜, 严育忠, 杨德平, 等. 耐碳青霉烯类高毒力肺炎克雷伯菌的研究进展[J]. 检验医学与临床, 2023, 20(23): 3531-3536.
[14] 施瑜, 王震, 杨奇, 等. 高毒力肺炎克雷伯菌的毒力基因研究[J]. 中国现代药物应用, 2025, 19(13): 177-180.
[15] 赵杭, 何知恩, 张慧敏, 等. 高毒力肺炎克雷伯菌临床感染特征及毒力因子研究进展[J]. 国外医药(抗生素分册), 2023, 44(2): 83-90.
[16] 弓浩胜, 李艺佳, 凌明智, 等. 血流感染中高毒力肺炎克雷伯菌的荚膜多糖血清型特点、多位点序列分型研究[J]. 医药论坛杂志, 2024, 45(5): 468-471.
[17] Huang, Y., Cai, Y., He, W., et al. (2024) Virulence Gene Distribution and Molecular Epidemiological Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in the ICU. Journal of Central South University. Medical Sciences, 49, 730-736.
[18] Zhou, Y., Zhang, Y.X., Tian, Y.R., et al. (2023) Clinical and Microbiological Characteristics of Endogenous Klebsiella pneumoniae Endophthalmitis in a Tertiary Hospital in Shanghai, China. Ocular Immunology and Inflammation, 32, 940-946.
[19] Liu, Y., Wang, Z., Jian, Z., Liu, P., Li, Y., Qin, F., et al. (2025) Nosocomial Transmission, Adaption and Clinical Outcomes of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae. BMC Microbiology, 25, Article No. 376. [Google Scholar] [CrossRef] [PubMed]
[20] 叶春枚, 骆沿极, 湛东进, 等. 重症患者中hvKP与cKP分子特征对比及耐药性差异分析[J]. 实用预防医学, 2025, 32(2): 234-238.
[21] 曹身云, 李震, 赵书平. 高毒力肺炎克雷伯菌的研究进展[J]. 国际检验医学杂志, 2022, 43(7): 864-868.
[22] 韩睿辉, 杜艳. 高毒力肺炎克雷伯菌致病机制中铁载体毒力基因的作用[J]. 华西医学, 2020, 35(8): 991-994.
[23] Russo, T.A., MacDonald, U., Hassan, S., Camanzo, E., LeBreton, F., Corey, B., et al. (2021) An Assessment of Siderophore Production, Mucoviscosity, and Mouse Infection Models for Defining the Virulence Spectrum of Hypervirulent Klebsiella pneumoniae. mSphere, 6, e00045-21. [Google Scholar] [CrossRef] [PubMed]
[24] Pan, T. and Li, Q. (2025) Mobile Genetic Elements in Klebsiella pneumoniae. Journal of Bacteriology, 207, e00012-25. [Google Scholar] [CrossRef] [PubMed]
[25] 董秀涛, 崔晓笛, 石晓红, 等. 高毒力肺炎克雷伯菌的微生物学特征与毒力因子研究进展[J]. 国际检验医学杂志, 2023, 44(11): 1382-1387.
[26] 张可依, 陶传敏. 高毒力肺炎克雷伯菌的定义和毒力相关因素研究进展[J]. 四川医学, 2021, 42(1): 86-92.
[27] 贾志钰, 张海鹏, 宋志忠. 肺炎克雷伯菌毒力因子及耐药研究进展[J]. 中国地方病防治, 2022, 37(4): 275-277.
[28] 张吟. 血流感染高毒力肺炎克雷伯菌Ⅵ型分泌系统(T6SS)和高粘液表型的微生物学特性[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2022.
[29] Mohamed, N.A., et al. (2023) Type VI Secretion System (T6SS) in Klebsiella pneumoniae, Relation to Antibiotic Resistance and Biofilm Formation. Iranian Journal of Microbiology, 15, 601-608.
[30] 陆颖, 朱志军, 朱梅. 肺炎克雷伯菌耐药机制研究进展[J]. 中华医院感染学杂志, 2020, 30(7): 1116-1120.
[31] Lee, A.H.Y., Porto, W.F., de Faria Jr, C., Dias, S.C., Alencar, S.A., Pickard, D.J., et al. (2021) Genomic Insights into the Diversity, Virulence and Resistance of Klebsiella pneumoniae Extensively Drug Resistant Clinical Isolates. Microbial Genomics, 7, Article ID: 000613. [Google Scholar] [CrossRef] [PubMed]
[32] 刘轶, 匡慧慧, 郭素琴, 等. 一株多药耐药肺炎克雷伯菌全基因组测序及耐药组学分析[J]. 中华医院感染学杂志, 2024, 34(20): 3041-3045.
[33] Cai, M.F., et al. (2022) A Plasmid with Conserved Phage Genes Helps Klebsiella pneumoniae Defend against the Invasion of Transferable DNA Elements at the Cost of Reduced Virulence. Frontiers in Microbiology, 13, Article 827545.
[34] 刘洁, 赵建平. 耐碳青霉烯类肺炎克雷伯菌生物膜形成及多黏菌素B联合替加环素的体外抗菌活性[J]. 中国抗生素杂志, 2025, 50(7): 789-797.
[35] Li, L., Gao, X., Li, M., Liu, Y., Ma, J., Wang, X., et al. (2024) Relationship between Biofilm Formation and Antibiotic Resistance of Klebsiella pneumoniae and Updates on Antibiofilm Therapeutic Strategies. Frontiers in Cellular and Infection Microbiology, 14, Article 1324895. [Google Scholar] [CrossRef] [PubMed]
[36] 周彤, 周秀娟, 龙坤兰, 等. 肺炎克雷伯菌生物膜治疗的研究进展[J]. 中国抗生素杂志, 2023, 48(6): 636-642.
[37] 王均梅, 郑楠, 焦玲, 等. 血培养中病原菌的耐药性及耐碳青霉烯肠杆菌目细菌的耐药基因分析[J]. 分子诊断与治疗杂志, 2025, 17(8): 1396-1399.
[38] 冯福英, 洪宇, 杨湘越, 等. 耐亚胺培南肺炎克雷伯菌耐药基因检测与分子流行病学研究[J]. 中华医院感染学杂志, 2016, 26(12): 2650-2653.
[39] 丁家伟, 张梦颖, 虎子单, 等. 碳青霉烯类耐药高毒力肺炎克雷伯菌耐药机制及进化研究进展[J]. 中华医院感染学杂志, 2025, 35(16): 2535-2540.
[40] Ling, Y.H., Hui, X.W., Wen, Z., et al. (2022) Epidemiological Characteristics and Molecular Evolution Mechanisms of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae. Frontiers in Microbiology, 13, Article 1003783.
[41] Morteza, K., Ali, H.R., Hadi, E., et al. (2022) Klebsiella pneumoniae: An Update on Antibiotic Resistance Mechanisms. Future Micro-Biology, 18, 65-81.
[42] 王鲁峰, 张惠, 杨烨, 等. 整合子在碳青霉烯耐药及敏感肺炎克雷伯菌中的分布特征及耐药相关性分析[J]. 浙江临床医学, 2024, 26(9): 1268-1271, 1276.
[43] Sabença, C., Costa, E., Sousa, S., Barros, L., Oliveira, A., Ramos, S., et al. (2023) Evaluation of the Ability to Form Biofilms in KPC-Producing and ESBL-Producing Klebsiella pneumoniae Isolated from Clinical Samples. Antibiotics, 12, Article 1143. [Google Scholar] [CrossRef] [PubMed]
[44] 陈夏容, 张华平, 杨栋勇, 等. 医院和社区感染耐碳青霉烯类肺炎克雷伯菌检出情况及耐药趋势[J]. 中华医院感染学杂志, 2025, 35(14): 2159-2163.
[45] Yap, P.S., Cheng, W., Chang, S., Lim, S.E. and Lai, K. (2022) MGRB Mutations and Altered Cell Permeability in Colistin Resistance in Klebsiella pneumoniae. Cells, 11, Article 2995. [Google Scholar] [CrossRef] [PubMed]
[46] Xia, Z., zhou, J., Gao, N., Li, G., Liu, R., Lu, G., et al. (2024) AcrAB-TolC Efflux Pump Overexpression and Tet(A) Gene Mutation Increase Tigecycline Resistance in Klebsiella pneumoniae. World Journal of Microbiology and Biotechnology, 40, Article No. 233. [Google Scholar] [CrossRef] [PubMed]
[47] Avendaño-Ortiz, J., Ponce-Alonso, M., Llanos-González, E., Barragán-Prada, H., Barbero-Herranz, R., Lozano-Rodríguez, R., et al. (2023) The Impact of Colistin Resistance on the Activation of Innate Immunity by Lipopolysaccharide Modification. Infection and Immunity, 91, e0001223. [Google Scholar] [CrossRef] [PubMed]