{"id":39563,"date":"2024-08-12T05:10:07","date_gmt":"2024-08-12T05:10:07","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=39563"},"modified":"2024-08-12T05:10:07","modified_gmt":"2024-08-12T05:10:07","slug":"%e8%82%ba%e7%82%8e%e5%85%8b%e9%9b%b7%e4%bc%af%e8%8f%8c%e3%80%81%e7%b1%bb%e8%82%ba%e7%82%8e%e5%85%8b%e9%9b%b7%e4%bc%af%e8%8f%8c%e5%92%8c%e5%8f%98%e6%a0%96%e5%85%8b%e9%9b%b7%e4%bc%af%e8%8f%8c%e7%9a%84","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=39563","title":{"rendered":"\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u3001\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u548c\u53d8\u6816\u514b\u96f7\u4f2f\u83cc\u7684\u7814\u7a76\u8fdb\u5c55"},"content":{"rendered":"

\u6458\u8981\uff1a\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u4e34\u5e8a\u5206\u79bb\u682a\u662f\u4e00\u79cd\u6709\u835a\u819c\u7684\u9769\u5170\u9634\u6027\u7c97\u77ed\u6746\u83cc, \u662f\u4e34\u5e8a\u4e0a\u91cd\u8981\u7684\u673a\u4f1a\u81f4\u75c5\u83cc\u3002\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u4e34\u5e8a\u5206\u79bb\u682a\u57fa\u56e0\u95f4\u5b58\u5728\u5dee\u5f02, \u4f9d\u636e\u7cfb\u7edf\u53d1\u80b2\u6811\u53ef\u5206\u4e3a\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(Klebsiella pneumoniae, Kp\u2160)\u3001\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(Klebsiella quasipneumoniae, Kp\u2161)\u548c\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(Klebsiella variicola, Kp\u2162), \u4e09\u8005\u751f\u6001\u5206\u5e03\u3001\u57fa\u56e0\u578b\u3001\u8010\u836f\u6027\u3001\u6bd2\u529b\u7279\u5f81\u4ee5\u53ca\u81f4\u75c5\u6027\u5b58\u5728\u663e\u8457\u5dee\u5f02, \u4e3a\u611f\u67d3\u6027\u75be\u75c5\u7cbe\u51c6\u6cbb\u7597\u5e26\u6765\u65b0\u7684\u6311\u6218\u3002\u672c\u6587\u5bf9Kp\u2160\u3001Kp\u2161\u3001Kp\u2162\u7684\u9274\u5b9a\u3001\u6d41\u884c\u7279\u70b9\u53ca\u81f4\u75c5\u7279\u70b9\u7684\u6700\u65b0\u7814\u7a76\u8fdb\u5c55\u8fdb\u884c\u7efc\u8ff0\u3002<\/p>\n

\u5173\u952e\u8bcd\uff1a\u80ba\u708e\u514b\u96f7\u4f2f\u83cc    \u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc    \u53d8\u6816\u514b\u96f7\u4f2f\u83cc    \u8010\u836f    \u6bd2\u529b    \u81f4\u75c5\u6027<\/p>\n

\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(Klebsiella pneumoniae, Kp)\uff0c\u662f\u4e00\u79cd\u6709\u835a\u819c\u7684\u9769\u5170\u9634\u6027\u7c97\u77ed\u6746\u83cc\uff0c\u5c5e\u4e8e\u80a0\u6746\u83cc\u76ee\u514b\u96f7\u4f2f\u83cc\u5c5e\uff0c\u662f\u4e34\u5e8a\u4e0a\u91cd\u8981\u7684\u673a\u4f1a\u81f4\u75c5\u83cc\u3002\u4e34\u5e8a\u4e0aKp\u56e0\u5176\u9ad8\u8010\u836f\u7387\u53ca\u9ad8\u4f20\u64ad\u6027\u6210\u4e3a\u5f15\u8d77\u793e\u533a\u3001\u533b\u9662\u611f\u67d3\u7684\u91cd\u8981\u81f4\u75c5\u83cc\uff0c\u7ea6\u5360\u514b\u96f7\u4f2f\u83cc\u5c5e\u5206\u79bb\u7387\u768495%\u4ee5\u4e0a[1]<\/sup>\u3002\u7814\u7a76[1-2]<\/sup>\u8868\u660eKp\u5177\u6709\u5e7f\u6cdb\u7684\u751f\u6001\u5206\u5e03\u3001\u591a\u6837\u7684DNA\u7ec4\u6210\u3001\u4e30\u5bcc\u7684\u6297\u83cc\u836f\u7269\u8010\u836f\u57fa\u56e0(AMR)\u548c\u6781\u9ad8\u7684\u8d28\u7c92\u4e30\u5ea6\uff0c\u662f\u8010\u836f\u57fa\u56e0\u5728\u73af\u5883\u4e0e\u9769\u5170\u9634\u6027\u83cc\u4e4b\u95f4\u4f20\u64ad\u7684\u4e3b\u8981\u5a92\u4ecb\u3002\u55b9\u8bfa\u916e\u8010\u836f\u57fa\u56e0\u9996\u6b21\u5206\u79bb\u4e8eKp\u83cc\u682a\uff1b\u8010\u78b3\u9752\u9709\u70ef\u7c7b\u57fa\u56e0KPC\u3001NDM-1\u548cOXA-48\u7b49\u901a\u8fc7Kp\u5728\u73af\u5883\u4e0e\u4e34\u5e8a\u75c5\u539f\u83cc\u4e4b\u95f4\u8fdb\u884c\u4f20\u64ad\u3002\u968f\u7740\u4ea7\u8d85\u5e7f\u8c31\u03b2-\u5185\u9170\u80fa\u9176(ESBLs)\u3001\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f(CRKp)\u3001\u9ad8\u6bd2\u529b\u83cc\u682a(hvKp)\u7684\u51fa\u73b0\u5927\u5927\u52a0\u5267\u4e86Kp\u611f\u67d3\u6cbb\u7597\u7684\u96be\u5ea6\u3002\u968f\u7740\u57fa\u56e0\u7ec4\u5b66\u53ca\u9ad8\u901a\u91cf\u6d4b\u5e8f\u6280\u672f\u7684\u53d1\u5c55\uff0c\u4f9d\u636eKp\u4e34\u5e8a\u5206\u79bb\u682a\u6838\u82f7\u9178\u95f4\u7684\u5dee\u5f02\u53ef\u5206\u4e3a\u4e09\u4e2a\u7cfb\u7edf\u7fa4\uff1a\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(Kp\u2160)\u3001\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(Kp\u2161)\u548c\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(Kp\u2162)\uff0cKp\u2161\u53c8\u53ef\u8fdb\u4e00\u6b65\u5206\u4e3aKp\u2161-A\u548cKp\u2161-B\u3002\u56fd\u5185\u5916\u7814\u7a76\u53d1\u73b0Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u7cfb\u7edf\u7fa4\u83cc\u682a\u7684\u751f\u6001\u5206\u5e03\u3001\u57fa\u56e0\u578b\u3001\u8010\u836f\u6027\u3001\u6bd2\u529b\u7279\u5f81\u4ee5\u53ca\u81f4\u75c5\u6027\u5b58\u5728\u663e\u8457\u5dee\u5f02\uff0c\u56e0\u6b64\u83cc\u682a\u7684\u5206\u7fa4\u7814\u7a76\u5bf9\u4e2a\u4f53\u5316\u7cbe\u51c6\u533b\u7597\u7684\u63a8\u8fdb\u548c\u9488\u5bf9\u6027\u6cbb\u7597\u6307\u5357\u5236\u5b9a\u6781\u4e3a\u6709\u76ca\u3002\u672c\u6587\u901a\u8fc7\u603b\u7ed3\u8fd1\u51e0\u5e74\u56fd\u5185\u5916\u7684\u6700\u65b0\u7814\u7a76\u4ee5\u53ca\u4e34\u5e8a\u62a5\u9053\uff0c\u5bf9Kp\u2160\u3001Kp\u2161\u3001Kp\u2162\u7684\u7279\u5f81\u8fdb\u884c\u7efc\u8ff0\uff0c\u4e3a\u611f\u67d3\u6027\u75be\u75c5\u7cbe\u51c6\u533b\u7597\u3001\u533b\u9662Kp\u611f\u67d3\u6027\u75be\u75c5\u9632\u63a7\u6307\u5357\u5236\u5b9a\u63d0\u4f9b\u7406\u8bba\u4f9d\u636e\u3002<\/p>\n

1 Kp\u4e34\u5e8a\u5206\u79bb\u682a\u611f\u67d3\u73b0\u72b6<\/p>\n

\u5168\u7403\u533b\u9662\u9762\u4e34\u7684\u6297\u83cc\u836f\u7269\u8010\u836f\u6027\u5371\u673a\u662f\u7531ESKAPE\u75c5\u539f\u4f53(\u5c4e\u80a0\u7403\u83cc\u3001\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u3001\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u3001\u9c8d\u66fc\u4e0d\u52a8\u6746\u83cc\u3001\u94dc\u7eff\u5047\u5355\u80de\u83cc\u3001\u80a0\u6746\u83cc\u5c5e\u7ec6\u83cc)\u9a71\u52a8\u7684\uff0c\u8fd9\u4e9b\u75c5\u539f\u4f53\u662f\u5bfc\u81f4\u5927\u591a\u6570\u60a3\u8005\u611f\u67d3\u540e\u4f7f\u7528\u6297\u83cc\u836f\u7269\u6cbb\u7597\u5931\u8d25\u7684\u539f\u56e0[3]<\/sup>\u30022019\u5e74\u4e2d\u56fd\u7ec6\u83cc\u8010\u836f\u76d1\u6d4b\u7f51\u6570\u636e\u663e\u793aKp\u5c45\u4e34\u5e8a\u5206\u79bb\u7684\u9769\u5170\u9634\u6027\u83cc\u7b2c\u4e8c\u4f4d\uff0c\u4ec5\u6b21\u4e8e\u5927\u80a0\u57c3\u5e0c\u83cc\uff0c\u540c\u65f6\u8010\u78b3\u9752\u9709\u70ef\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(CRKp)\u68c0\u51fa\u7387\u81ea2013\u5e74\u4ee5\u6765\u6301\u7eed\u5347\u9ad8[4]<\/sup>\u3002Kp\u53ef\u5f15\u8d77\u547c\u5438\u7cfb\u7edf\u3001\u6ccc\u5c3f\u751f\u6b96\u7cfb\u7edf\u4ee5\u53ca\u4f24\u53e3\u7684\u611f\u67d3\uff0c\u4e5f\u53ef\u5bfc\u81f4\u83cc\u8840\u75c7\u548c\u809d\u8113\u80bf\u7b49\uff1b\u514d\u75ab\u529b\u4f4e\u4e0b\u7684\u7fa4\u4f53(\u5982\u65b0\u751f\u513f\u3001\u8001\u5e74\u4eba\u3001\u80bf\u7624\u3001\u81ea\u8eab\u514d\u75ab\u6027\u75be\u75c5\u7fa4\u4f53\u548c\u6709\u521b\u64cd\u4f5c\u7684\u60a3\u8005\u7b49)\u6613\u611f\u3002\u4e00\u9879\u6db5\u76d6\u4e2d\u56fd14\u4e2a\u770125\u6240\u4e09\u7ea7\u7532\u7b49\u533b\u9662\u7684\u591a\u4e2d\u5fc3\u4e34\u5e8a\u7814\u7a76[3]<\/sup>\u663e\u793a\uff0c\u5728664\u4e2a\u4e34\u5e8a\u5206\u79bb\u6807\u672c\u4e2d\uff0c\u8010\u78b3\u9752\u9709\u70ef\u7c7b\u80a0\u6746\u83cc\u76ee\u7ec6\u83cc(CRE)\u4e2dKp\u5360\u6bd4\u4e3a73.9%\uff0c\u8010\u836f\u73b0\u72b6\u4e25\u5cfb\u3002<\/p>\n

\u5728\u5206\u5b50\u751f\u7269\u5b66\u9886\u57df\uff0c\u5f53DNA\u6742\u4ea4\u7ed3\u679c\u5927\u4e8e70%\u65f6\u8003\u8651\u4e3a\u540c\u4e00\u7269\u79cd\u3002\u7cfb\u7edf\u8fdb\u5316\u6811\u7814\u7a76[5]<\/sup>\u8868\u660e\uff0c\u4e34\u5e8a\u5206\u79bb\u9274\u5b9a\u7684Kp\u53ef\u5206\u4e3a\u4e09\u4e2a\u7cfb\u7edf\u7fa4\uff1aKp\u2160\u3001Kp\u2161\u548cKp\u2162\uff0c\u7cfb\u7edf\u7fa4\u95f4\u6838\u82f7\u9178\u5dee\u5f02\u4e3a3%~4%\u3002Kp\u2160\u83cc\u682a\u662f\u4e34\u5e8a\u5e38\u89c1\u7684\u75c5\u539f\u83cc\uff1b\u7ea694%\u7684Kp\u2161\u83cc\u682a\u5206\u79bb\u81ea\u4eba\u7c7b(50%\u4ee5\u4e0a\u4e3a\u80a0\u9053\u5b9a\u690d)\uff1bKp\u2162\u83cc\u682a\u80fd\u591f\u56fa\u6c2e\uff0c\u5e7f\u6cdb\u5b58\u5728\u4e8e\u690d\u7269\u3001\u6c34\u4f53\u3001\u571f\u58e4\u3001\u98df\u8349\u751f\u7269\u7684\u9ecf\u819c\u8868\u9762\uff0c\u4e0e\u73af\u5883\u5bc6\u5207\u76f8\u5173\uff1bMart\u00ednez-Romero\u7b49[6]<\/sup>\u901a\u8fc7\u8ba1\u7b97\u673a\u5206\u6790\u548c\u57fa\u56e0\u7ec4\u6570\u636eJaccard\u5206\u6790\u8bc1\u660e\u4e86Kp\u2161\u548cKp\u2162\u4ece\u73af\u5883\u611f\u67d3\u4eba\u7684\u53ef\u80fd\u6027\u3002Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u4e09\u79cd\u7ec6\u83cc\u611f\u67d3\u7684\u6d41\u884c\u75c5\u5b66\u5b58\u5728\u5dee\u5f02\uff0c\u5173\u4e8eKp\u4e34\u5e8a\u5206\u79bb\u682a\u5206\u7fa4\u7684\u6d41\u884c\u75c5\u5b66\u7814\u7a76\u6709\u52a9\u4e8e\u4e34\u5e8a\u79d1\u5ba4\u9632\u63a7\u5de5\u4f5c\u7684\u5b9e\u65bd\uff0c\u4f7f\u5e7f\u5927\u60a3\u8005\u53d7\u76ca\u3002<\/p>\n

2 Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u7684\u9274\u5b9a<\/p>\n

\u4e34\u5e8a\u5e38\u7528\u7684\u7ec6\u83cc\u9274\u5b9a\u6280\u672f\u662f\u57fa\u4e8e\u751f\u5316\u8bd5\u9a8c\u7684VITEK-2\u9274\u5b9a\u4eea\u548c\u57fa\u4e8e\u86cb\u767d\u8d28\u7ec4\u5b66\u7684\u57fa\u8d28\u8f85\u52a9\u6fc0\u5149\u89e3\u5438\u7535\u79bb\u98de\u884c\u65f6\u95f4\u8d28\u8c31(MALDI-TOF-MS)\u3002\u57fa\u4e8e\u751f\u5316\u8bd5\u9a8c\u7684\u9274\u5b9a\u7cfb\u7edf\u5c1a\u4e0d\u80fd\u5b9e\u73b0Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u7684\u5206\u7fa4\uff0c\u56e0\u6b64\u4e34\u5e8a\u4e0a\u4f7f\u7528\u836f\u654f\u5361\u8fdb\u884c\u9274\u5b9a\u4f1a\u964d\u4f4eKp\u2161\u548cKp\u2162\u5206\u79bb\u7387\u3002MALDI-TOF-MS\u7cfb\u7edf\u901a\u8fc7\u5c06\u5f85\u9274\u5b9a\u83cc\u682a\u8d28\u8c31\u56fe\u4e0e\u6570\u636e\u5e93\u4e2d\u7684\u8d28\u8c31\u56fe\u5bf9\u6bd4\u5b9e\u73b0\u83cc\u79cd\u9274\u5b9a\uff0c\u56e0\u6b64\u9274\u5b9a\u83cc\u79cd\u8303\u56f4\u4e3b\u8981\u4e0e\u88c5\u914d\u7684\u9274\u5b9a\u6587\u5e93\u76f8\u5173\u3002\u76ee\u524d\u88c5\u914d\u6709Bruker\u6587\u5e936.0.0.0\u7248\u672c(\u5305\u542bKp\u2160\u3001Kp\u2161\u548cKp\u2162\u83cc\u682a\u6807\u51c6\u8c31\u56fe)\u7684MALDI-TOF-MS\u7cfb\u7edf\u53ef\u5b9e\u73b0Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u7684\u5206\u7fa4[7-8]<\/sup>\u3002\u4f46\u53d7\u6807\u51c6\u8c31\u56fe\u5bf9\u5e94\u7684\u83cc\u682a\u6570\u636e\u91cf\u7684\u9650\u5236\uff0c\u5305\u542bKp\u2160\u3001Kp\u2161\u548cKp\u2162\u83cc\u682a\u6807\u51c6\u8c31\u56fe\u7684\u7ec6\u83cc\u6587\u5e93\u5728\u4e34\u5e8a\u5c1a\u672a\u5e7f\u6cdb\u5e94\u7528\u3002\u57fa\u4e8e\u4ee5\u4e0a\u73b0\u72b6\uff0cKp\u2161\u548cKp\u2162\u5728\u4e34\u5e8a\u5206\u79bb\u7387\u8f83\u4f4e\u3002<\/p>\n

\u76ee\u524dKp\u2160\u3001Kp\u2161\u548cKp\u2162\u9274\u522b\u7684\u5206\u5b50\u751f\u7269\u5b66\u6280\u672f\u5305\u62ecPCR\u6cd5\u3001\u8fdb\u5316\u6811\u5206\u6790\u53ca\u57fa\u56e0\u6d4b\u5e8f\u7b49\u3002PCR\u6cd5\u4e3b\u8981\u662f\u57fa\u4e8e\u67d3\u8272\u4f53\u4e0a\u03b2- \u5185\u9170\u80fa\u9176\u591a\u6837\u6027\u8bbe\u8ba1\u7684\u591a\u91cdPCR\u548crpoB\u57fa\u56e0\u7684\u7cfb\u7edf\u53d1\u80b2\u6811\u5206\u6790\u6765\u9274\u5b9aKp\u2160(blaSHV<\/sub>)\u3001Kp\u2161(blaOKP<\/sub>)\u548cKp\u2162(blaLEN<\/sub>)\uff0c\u7531\u4e8e\u90e8\u5206Kp\u2162\u643a\u5e26\u7684\u03b2-\u5185\u9170\u80fa\u9176\u4e3ablaOKP<\/sub>\uff0c\u56e0\u6b64\u8be5\u6280\u672f\u4e0d\u80fd\u5f88\u597d\u5730\u533a\u5206Kp\u2161\u548cKp\u2162[9]<\/sup>\u3002\u57fa\u56e0\u7ec4\u5b66\u5206\u6790\u4e3b\u8981\u901a\u8fc7\u5168\u57fa\u56e0\u6d4b\u5e8f\u5206\u6790(WGS)\u8fdb\u884c\u7ec6\u83cc\u75c5\u539f\u4f53\u7684\u9274\u5b9a\u5206\u7fa4\uff0c\u6b64\u5916KlebSeq\u3001\u5355\u6838\u82f7\u9178\u591a\u6001\u6027(SNPs)\u3001ANI\u5747\u53ef\u7528\u4e8e\u514b\u96f7\u4f2f\u83cc\u5c5e\u7b5b\u9009\u548c\u6d41\u884c\u75c5\u5b66\u76d1\u6d4b[10]<\/sup>\u3002\u4f46\u76ee\u524dPCR\u6cd5\u3001\u8fdb\u5316\u6811\u5206\u6790\u548c\u57fa\u56e0\u6d4b\u5e8f\u7b49\u5206\u5b50\u751f\u7269\u5b66\u624b\u6bb5\u4e3b\u8981\u7528\u4e8e\u79d1\u5b66\u7814\u7a76\uff0c\u5c1a\u672a\u5728\u4e34\u5e8a\u666e\u53ca\u3002<\/p>\n

3 Kp\u2160\u7684\u836f\u7269\u654f\u611f\u6027\u3001\u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u60273.1 \u836f\u7269\u654f\u611f\u6027<\/p>\n

\u65e9\u572820\u4e16\u7eaa60\u5e74\u4ee3\u5c31\u53d1\u73b0Kp\u4e34\u5e8a\u5206\u79bb\u682a\u643a\u5e26\u5bf9\u9752\u9709\u7d20\u5929\u7136\u8010\u836f\u7684A\u7c7b\u67d3\u8272\u4f53\u7f16\u7801\u7684\u03b2-\u5185\u9170\u80fa\u9176\u57fa\u56e0[11]<\/sup>\u3002Kp\u2160\u7684blaSHV<\/sub>\u8010\u836f\u57fa\u56e0\u4ecb\u5bfc\u83cc\u682a\u5bf9\u6c28\u82c4\u897f\u6797\u7b49\u5929\u7136\u8010\u836f\u300220\u4e16\u7eaa80\u5e74\u4ee3\u5fb7\u56fd\u4ece\u4e00\u4f8bICU\u60a3\u8005\u5206\u79bb\u7684Kp\u4e2d\u53d1\u73b0\u4e86\u7b2c\u4e00\u4e2a\u53ef\u6c34\u89e3\u5305\u62ec\u7b2c\u4e09\u4ee3\u5934\u5b62\u83cc\u7d20\u7c7b\u53ca\u6c28\u66f2\u5357\u5728\u5185\u7684\u6297\u751f\u7d20\u7684ESBLs\u57fa\u56e0(blaSHV<\/sub>)\uff0c\u968f\u540eESBLs\u7f16\u7801\u57fa\u56e0blaSHV-2<\/sub>\u3001blaTEM-3<\/sub>\u3001blaCTX-M<\/sub>\u88ab\u53d1\u73b0[3]<\/sup>\u3002\u6839\u636e\u4e16\u754c\u536b\u751f\u7ec4\u7ec7(WHO)\u7684\u62a5\u544a[10]<\/sup>\uff0c\u643a\u5e26ESBLs\u7684Kp\u2160\u5728\u4e16\u754c\u8303\u56f4\u5185\u8986\u76d6\u7387\u8fbe\u523050%\uff0c\u793e\u533a\u5206\u79bb\u7387\u8fbe\u523030%\uff0c\u4e25\u91cd\u5a01\u80c1\u4eba\u7c7b\u5065\u5eb7\u3002\u78b3\u9752\u9709\u70ef\u7c7b\u836f\u7269\u4f5c\u4e3a\u4ea7ESBLs\u83cc\u682a\u7684\u5e38\u89c4\u6cbb\u7597\u836f\u7269\uff0c\u5728\u836f\u7269\u9009\u62e9\u7684\u538b\u529b\u4e0b\uff0c\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f\u83cc\u682a\u968f\u4e4b\u51fa\u73b0\uff0c\u5176\u4e2dCRKp\u662f\u5e38\u89c1\u7684\u8010\u78b3\u9752\u9709\u70ef\u7c7b\u80a0\u6746\u83cc\u76ee\u7ec6\u83cc(CRE)\u3002CRKp\u51fa\u73b0\u7684\u4e3b\u8981\u673a\u5236\u662f\u4ea7\u78b3\u9752\u9709\u70ef\u9176\uff0c\u7ec6\u83cc\u57fa\u56e0\u7ec4\u57fa\u56e0\u7a81\u53d8\u3001\u836f\u7269\u5916\u6392\u6cf5\u7684\u6539\u53d8\u3001AmpC\u9176\u548cESBLs\u5f02\u5e38\u8868\u8fbe\u4e5f\u53ef\u5bfc\u81f4CRKp\u51fa\u73b0\u3002\u5168\u57fa\u56e0\u7ec4\u6d4b\u5e8f\u53d1\u73b0[12]<\/sup>CRKp\u57fa\u56e0\u7ec4\u5305\u62ec16\u4e2a\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f\u57fa\u56e0(12\u4e2a\u4f4d\u4e8e\u8d28\u7c92\u4e2d\uff0c4\u4e2a\u4f4d\u4e8e\u67d3\u8272\u4f53\u4e2d)\u3002\u78b3\u9752\u9709\u70ef\u9176\u662f\u6307\u80fd\u591f\u660e\u663e\u6c34\u89e3\u4e9a\u80fa\u57f9\u5357\u6216\u7f8e\u7f57\u57f9\u5357\u7b49\u78b3\u9752\u9709\u70ef\u7c7b\u6297\u751f\u7d20\u7684\u4e00\u7c7b\u03b2-\u5185\u9170\u80fa\u9176\uff0c\u6309\u7167Ambler\u5206\u5b50\u5206\u7c7b\u65b9\u6cd5\uff0c\u53ef\u5206\u4e3aA\u3001B\u3001D 3\u7c7b\u9176\u3002\u5176\u4e2dA\u7c7b\u3001D\u7c7b\u4e3a\u4e1d\u6c28\u9178\u9176\uff0c\u5c5e\u4e8eBush\u5206\u7fa4\u4e2d\u7684\u7b2c2f\u548c2d\u4e9a\u7ec4\uff1bB\u7c7b\u4e3a\u91d1\u5c5e\u9176\uff0c\u5c5e\u4e8eBush\u5206\u7fa4\u4e2d\u7684\u7b2c3\u7ec4\uff0c\u53ef\u7531\u67d3\u8272\u4f53\u3001\u8d28\u7c92\u6216\u8f6c\u5ea7\u5b50\u4ecb\u5bfc\u3002blaKPC<\/sub>\u662fKp\u2160\u6700\u5e38\u89c1\u7684\u78b3\u9752\u9709\u70ef\u9176\uff0c\u5c5eA\u7c7b\u4e1d\u6c28\u9178\u78b3\u9752\u9709\u70ef\u9176\uff0c\u76ee\u524d\u6211\u56fd\u6d41\u884c\u7684\u4e3b\u8981\u662fblaKPC-1<\/sub>\u548cblaKPC-2<\/sub>[13]<\/sup>\uff1bD\u7c7b\u9176blaOXA-48<\/sub>\u4e0eCRKp\u5bc6\u5207\u76f8\u5173\uff0cblaOXA-48<\/sub>\u9633\u6027\u7684Kp\u2160\u5bf9\u4e9a\u80fa\u57f9\u5357\u9ad8\u5ea6\u8010\u836f[14]<\/sup>\uff1bB\u7c7b\u91d1\u5c5e\u9176blaIMP<\/sub>\u3001blaNDM-1<\/sub>\u548cblaVIM<\/sub>\u7b49\u5747\u4e0e\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836fKp\u2160\u76f8\u5173[13]<\/sup>\u3002\u9664\u6b64\u4e4b\u5916\uff0cKp\u2160\u4e2d\u5916\u6392\u6cf5OqxAB\u548cAcrAB\u7684\u8868\u8fbe\u548c\/\u6216\u6d3b\u5316\u4e0e\u591a\u79cd\u6297\u83cc\u836f\u7269(\u5982\u6c1f\u55b9\u8bfa\u916e\u7c7b\u3001\u544b\u5583\u59a5\u56e0\u3001\u66ff\u683c\u73af\u7d20\u3001\u6c2f\u9709\u7d20\u548c\u78b3\u9752\u9709\u70ef\u7c7b) \u7684\u8010\u836f\u6027\u76f8\u5173\uff1b\u5916\u819cOmpK36\u7684\u7279\u5f02\u6027\u7a81\u53d8\u6216\u4e22\u5931\u5728\u5f88\u5927\u7a0b\u5ea6\u4e0a\u52a0\u5267\u4e86Kp\u2160\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f\u7684\u95ee\u9898[3]<\/sup>\uff0c\u5e76\u53ef\u4ee5\u4f7fMIC\u8fdc\u9ad8\u4e8e\u5355\u72ec\u7684\u78b3\u9752\u9709\u70ef\u9176\u6c34\u5e73\uff0c\u589e\u52a0\u4e34\u5e8a\u6cbb\u7597\u96be\u5ea6\u3002<\/p>\n

3.2 \u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u6027<\/p>\n

Kp\u662f\u5907\u53d7\u5173\u6ce8\u7684\u533b\u9662\u83b7\u5f97\u6027\u75c5\u539f\u4f53\uff0c\u5df2\u9274\u5b9a\u7684\u6bd2\u529b\u56e0\u5b50\u5305\u62ec\u835a\u819c\u3001\u8102\u591a\u7cd6\u3001\u94c1\u8f7d\u4f53\u3001\u83cc\u6bdb[2]<\/sup>\u3002\u835a\u819c\u4f5c\u4e3aKp\u2160\u6700\u91cd\u8981\u7684\u6bd2\u529b\u56e0\u5b50\u4e4b\u4e00\uff0c\u4e3b\u8981\u5e2e\u52a9\u7ec6\u83cc\u62b5\u5fa1\u541e\u566c\u548c\u8840\u6e05\u6740\u83cc\u4f5c\u7528\u3002\u57fa\u4e8e\u8840\u6e05\u5b66\u9274\u5b9a\u53ef\u533a\u520678\u79cd\u8840\u6e05\u578b\uff0c\u5176\u4e2dK1\u548cK2\u578b\u4e0e\u9ad8\u4fb5\u88ad\u6027\u75be\u75c5\u548c\u81f4\u75c5\u6027\u76f8\u5173\uff0c\u5728\u9ad8\u6bd2\u6027\u514b\u9686\u83cc\u682a\u4e2d\u9ad8\u5ea6\u4fdd\u5b88[15-17]<\/sup>\u3002\u835a\u819c\u8c03\u63a7\u57fa\u56e0rmpA\u3001rmpA2\u548cmagA\u7b49\u4e0eKp\u2160\u9ad8\u9ecf\u6db2\u8868\u578b\u5bc6\u5207\u76f8\u5173[17]<\/sup>\u3002\u8102\u591a\u7cd6(LPS)\u5373\u5185\u6bd2\u7d20\uff0c\u662f\u9769\u5170\u9634\u6027\u83cc\u5916\u819c\u7684\u4e3b\u8981\u6210\u5206\uff0c\u53ef\u53c2\u4e0eTLR\u4ecb\u5bfc\u7684\u4fe1\u53f7\u8f6c\u5bfc\uff0cLPS\u4fee\u9970\u53ef\u5e2e\u52a9\u7ec6\u83cc\u9003\u9038\u514d\u75ab\u7cfb\u7edf\u8bc6\u522b\uff0cwcaG\u57fa\u56e0\u4e0e\u8102\u591a\u7cd6\u53ca\u835a\u819c\u7684\u5f62\u6210\u76f8\u5173[18]<\/sup>\u3002\u94c1\u8f7d\u4f53\u7cfb\u7edf\u5305\u62ec\u94c1\u87af\u5408\u5206\u5b50\u4ee5\u53ca\u7528\u4e8e\u5185\u5316\u7684\u8868\u9762\u53d7\u4f53\uff0c\u53ef\u4ee5\u7ade\u4e89\u6027\u5730\u4ece\u5bbf\u4e3b\u86cb\u767d\u8d28\u6216\u5176\u4ed6\u6765\u6e90\u6e05\u9664\u94c1\u3002Kp\u4e2d\u6709\u56db\u4e2a\u94c1\u8f7d\u4f53\u7cfb\u7edf\uff1aentero- bactin\u3001yersiniabactin\u3001aerobactin\u548csalmochelin(\u5206\u522b\u7531Ent\u3001ybt\u3001iuc\u548ciro\u7f16\u7801)[19]<\/sup>\u3002Ent\u7f16\u7801\u7684\u6838\u5fc3\u7ed3\u6784\u53ef\u7834\u574f\u4e2d\u6027\u7c92\u7ec6\u80de\u7684\u9664\u94c1\u529f\u80fd\u5e76\u8bf1\u5bfc\u708e\u75c7\u53cd\u5e94\uff1biro\u4ecb\u5bfcEnt\u672b\u7aef\u7cd6\u57fa\u5316\uff0c\u4f7f\u7ec6\u80de\u4fdd\u6301\u9664\u94c1\u6d3b\u6027\uff1bybt\u548ciuc\u7684\u4eb2\u94c1\u6027\u6bd4Ent\u4f4e\u3002Kp\u2160\u4e2d\u5e38\u89c1\u7684\u83cc\u6bdb\u6709\u2160\u578b\u83cc\u6bdb(fm)\u548c\u2162\u578b\u83cc\u6bdb(mrk)\uff0c\u2162\u578b\u83cc\u6bdb\u548c\u8102\u591a\u7cd6\u662f\u751f\u7269\u819c\u4e2d\u6700\u91cd\u8981\u7684\u8868\u9762\u7ed3\u6784\uff0c\u2160\u578b\u83cc\u6bdb\u7684\u8f6c\u5f55\u5bf9\u83cc\u4f53\u6297\u541e\u566c\u8fc7\u7a0b\u81f3\u5173\u91cd\u8981\uff0c\u6709\u52a9\u4e8e\u7ec6\u83cc\u514d\u53d7\u5bbf\u4e3b\u514d\u75ab\u53cd\u5e94\u7684\u653b\u51fb\u3001\u541e\u566c[19]<\/sup>\u3002\u6b64\u5916\uff0cKp\u2160\u5916\u6392\u6cf5\u4e5f\u53ef\u80fd\u53d1\u6325\u6bd2\u529b\u4f5c\u7528\uff0c\u5982AcrAB\u53ef\u5f71\u54cdKp\u2160\u7ecf\u5c0f\u9f20\u547c\u5438\u7cfb\u7edf\u611f\u67d3\u540e\u7684\u6bd2\u529b\u3002\u8fd1\u6765\uff0c\u4ee5ST23\u4e3a\u4ee3\u8868\u7684\u9ad8\u9ecf\u6db2\u8868\u578b\u4e3a\u7279\u5f81\u7684Kp\u2160\u7684\u51fa\u73b0\uff0c\u7ed9\u4e34\u5e8a\u6cbb\u7597\u5e26\u6765\u6781\u5927\u6311\u6218\uff0c\u901a\u5e38\u8be5\u83cc\u682a\u643a\u5e26\u56db\u79cd\u83b7\u5f97\u6027\u94c1\u8f7d\u4f53\u7cfb\u7edf\u4ee5\u53carmpA\u548crmpA2\u7f16\u7801\u57fa\u56e0[20]<\/sup>\u3002\u9ad8\u6bd2\u6027\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(hvKp\u2160)\u5177\u6709\u4e30\u5bcc\u7684\u6bd2\u529b\u57fa\u56e0\u548c\u94c1\u8f7d\u4f53\u7cfb\u7edf\u3001\u5bf9\u5927\u591a\u6570\u6297\u83cc\u836f\u7269\u654f\u611f\uff0c\u5e38\u5f15\u8d77\u809d\u8113\u80bf\u3001\u8111\u819c\u708e\u3001\u80ba\u708e\u7b49\u75be\u75c5[21]<\/sup>\u3002\u4ee5\u5f80\u7684\u7814\u7a76[22]<\/sup>\u8ba4\u4e3a\u9ad8\u6bd2\u529b\u4e0e\u9ad8\u8010\u836f\u4e4b\u95f4\u8d1f\u6027\u76f8\u5173\uff0c\u968f\u7740\u56fd\u5185\u62a5\u9053\u7684\u540c\u65f6\u5177\u6709\u9ad8\u6bd2\u6027\u3001\u8010\u591a\u836f\u6027\u548c\u9ad8\u5ea6\u4f20\u64ad\u6027\u7684ST11\u578b\u8010\u78b3\u9752\u9709\u70ef\u7c7b\u9ad8\u6bd2\u6027\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(CR-hvKp)\u7684\u53d1\u73b0\uff0c\u8bc1\u660e\u4e86\u9ad8\u6bd2\u6027\u4e0e\u9ad8\u8010\u836f\u6027\u53ef\u540c\u65f6\u5b58\u5728\uff0c\u4e25\u91cd\u5a01\u80c1\u4eba\u7c7b\u5065\u5eb7\u3002<\/p>\n

4 Kp\u2161\u7684\u836f\u7269\u654f\u611f\u6027\u3001\u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u60274.1 \u836f\u7269\u654f\u611f\u6027<\/p>\n

Kp\u4e34\u5e8a\u5206\u79bb\u682a\u53ef\u6839\u636e\u57fa\u56e0\u7ec4\u95f4\u5dee\u5f02\u5206\u4e3a\u4e09\u7fa4\uff0c\u7b2c\u4e8c\u7fa4\u5bf9\u5e94\u4e8e\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc(K. quasipneumoniae, Kp\u2161)\uff0cKp\u2161\u53ef\u5206\u4e3a\u4e24\u4e2a\u4e9a\u7fa4\uff1aK. quasipneumoniae subsp. quasipneumoniae (Kp\u2161-A)\u548cK.quasipneumoniae subsp. similipneumoniae(Kp\u2161-B)[12]<\/sup>\u3002Kp\u2161\u67d3\u8272\u4f53\u4e0a\u643a\u5e26blaOKP<\/sub>\u57fa\u56e0\uff0c\u4ecb\u5bfc\u83cc\u682a\u5bf9\u9752\u9709\u7d20\u5929\u7136\u8010\u836f\uff0cblaOKP-A<\/sub>\u548cblaOKP-B<\/sub>\u5206\u522b\u5bf9\u5e94\u4e8eKp\u2161-A\u548cKp\u2161-B\u3002\u4e0eKp\u2160\u76f8\u6bd4\uff0cKp\u2161\u836f\u7269\u654f\u611f\u6027\u8f83\u9ad8\uff0c\u5176\u4e2d\u4e00\u90e8\u5206\u83cc\u682a\u80fd\u591f\u4ea7ESBLs\uff0c\u78b3\u9752\u9709\u70ef\u9176\u7f16\u7801\u57fa\u56e0blaNDM<\/sub>\u548cblaOXA-181<\/sub>\u66fe\u57282\u682aKp\u2161\u83cc\u682a\u4e2d\u68c0\u6d4b\u5230[23-24]<\/sup>\u3002Fuga\u7b49[25]<\/sup>\u62a5\u9053\u5728\u5df4\u897f\u5730\u533a2014\u5e74\u4ece\u4e00\u4f8b\u60a3\u8005\u7684\u809b\u62ed\u5b50\u4e2d\u5206\u79bb\u51fa\u542b\u6709blaNDM-1<\/sub>\u57fa\u56e0\u7684Kp\u2161-B\uff0c2017\u5e74\u4ece\u4e00\u4f8b\u704c\u6ce8\u6db2\u6807\u672c\u4e2d\u68c0\u51fa\u542bblaKPC-2<\/sub>\u57fa\u56e0\u7684Kp\u2161-A\u30022016\u5e74\u4ece\u9a6c\u6765\u897f\u4e9a\u4e00\u4f8b\u60a3\u8005\u5206\u79bb\u7684blaOXA181<\/sub>\u578bCRKp\u2161\u4e2dblaCTX-M-15<\/sub>\u57fa\u56e0\u548cOMPK37\u5b54\u86cb\u767d\u7f3a\u5931[24]<\/sup>\uff1b2019\u5e74\u6c99\u7279\u963f\u62c9\u4f2f[23]<\/sup>\u5206\u79bb\u7684Kp\u2161\u4e2d\u7684blaNDM-1<\/sub>\u7531mcr-9\u8d28\u7c92\u643a\u5e26\uff1b2019\u5e74\u5c3c\u65e5\u5229\u4e9a\u4e00\u5bb6\u533b\u9662\u65b0\u751f\u513f\u75c5\u533a\u4e2d\u643a\u5e26blaNDM-5<\/sub>\u57fa\u56e0\u7684Kp\u2161\u7684\u51fa\u73b0\u548c\u591a\u9ecf\u83cc\u7d20\u8010\u836f\u7684blaKPC-9<\/sub>\u57fa\u56e0\u578bKp\u2161\u83cc\u682a\u7684\u62a5\u9053[26]<\/sup>\uff0c\u63ed\u793a\u4e86\u8d28\u7c92\u5728\u8010\u836f\u6027\u4f20\u64ad\u4e2d\u7684\u91cd\u8981\u6027\u30022020\u5e74\u4e2d\u56fd\u4ece\u67d0\u65b0\u751f\u513f\u75c5\u533a[27]<\/sup>\u5206\u79bb\u7684ST2727\u83cc\u682a\uff0c\u5206\u7c7b\u4e0a\u5c5e\u4e8eKp\u2161-B\uff0c\u5bfc\u81f4\u4e00\u4f8b\u65b0\u751f\u513f\u8d25\u8840\u75c7\u6b7b\u4ea1\uff0c\u540c\u4e00\u75c5\u533a\u591a\u4f8b\u60a3\u8005\u611f\u67d3\uff0c\u867d\u7136ST2727\u83cc\u682a\u4e3a\u975e\u9ad8\u6bd2\u529b\u975e\u8010\u836f\u6027\u83cc\u682a\uff0c\u4f46\u5176\u66b4\u53d1\u6027\u6d41\u884c\u63ed\u793a\u4e86Kp\u2161\u5728\u533b\u9662\u73af\u5883\u4e2d\u7684\u8bca\u65ad\u548c\u76d1\u6d4b\u4ef7\u503c\u3002\u5df4\u897f\u91cc\u7ea6\u70ed\u5185\u5362\u7684\u4e00\u9879\u7814\u7a76\u53d1\u73b0ST3397\u4e34\u5e8a\u5206\u79bb\u682a\u662f\u6bd2\u529b\u57fa\u56e0magA\u7f3a\u4e4f\u3001blaNDM<\/sub>-blaCTX-M15<\/sub>\u591a\u91cd\u8010\u836f\u7684Kp\u2161-B\u83cc\u682a\uff0c\u8868\u73b0\u51fa\u5bf9\u5168\u90e8\u6297\u83cc\u836f\u7269\u8010\u836f\uff0c\u8747\u868a\u5728\u8010\u836f\u6027\u4f20\u9012\u4e2d\u7684\u4f5c\u7528\u4e0d\u53ef\u5ffd\u89c6\u3002<\/p>\n<\/p>\n

4.2 \u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u6027<\/p>\n

Kp\u2161\u83cc\u682a\u81f4\u75c5\u56e0\u7d20\u5305\u62ec\u835a\u819c\u3001\u8102\u591a\u7cd6\u3001\u94c1\u8f7d\u4f53\u3001\u83cc\u6bdb\u7b49\uff0cKp\u2161\u6700\u521d\u88ab\u8ba4\u4e3a\u662f\u4e00\u79cd\u5171\u751f\u7684\u80a0\u9053\u5b9a\u690d\u83cc\u7fa4\uff0c\u4e0d\u5177\u6709\u81f4\u75c5\u6027\uff0c\u7136\u800c\uff0c\u8fd1\u5e74\u6765\u7684\u7814\u7a76\u8868\u660eKp\u2161\u5728\u4e34\u5e8a\u4e0a\u53ef\u53d1\u6325\u81f4\u75c5\u6027\uff0c\u611f\u67d3\u6700\u5e38\u89c1\u7684\u6765\u6e90\u662f\u6ccc\u5c3f\u9053\u3001\u8840\u6db2\u3001\u547c\u5438\u9053\u53ca\u90e8\u5206\u521b\u53e3\u7b49\u3002\u8be5\u83cc\u682a\u81f4\u75c5\u6027\u4e0eKp\u2160\u7c7b\u4f3c\uff0c\u4f46\u6bd2\u529b\u57fa\u56e0\u4e30\u5ea6\u4f4e\u30022015\u5e74\u62a5\u9053\u4e86\u7b2c\u4e00\u4f8bKp\u2161-B\u9ad8\u9ecf\u6db2\u83cc\u682a\uff0c\u8be5\u83cc\u682a\u4e3a\u8840\u6d41\u611f\u67d3\u6765\u6e90\uff0c\u4e14\u8be5\u83cc\u682a\u4e2d\u9ad8\u9ecf\u6db2\u8c03\u63a7\u57fa\u56e0rmpA\u548crmpA2\u7f3a\u4e4f[5]<\/sup>\u30022016\u5e74\uff0c\u5df4\u897f\u5206\u79bb\u4e86\u4e00\u682a\u4ea7\u751fESBLs\u3001\u9ecf\u83cc\u7d20\u8010\u836f\u3001\u9ad8\u6bd2\u6027\u548c\u9ad8\u9ecf\u6db2Kp\u2161\u83cc\u682a[12]<\/sup>\uff0c\u540c\u5e74Breurec\u7b49[28]<\/sup>\u62a5\u9053\u7684K1\u578bKp\u2161\u83cc\u682a\u5177\u6709\u9ad8\u6bd2\u6027\uff0c\u542b\u6709\u7ed3\u5408\u5143\u4ef6ICEKp1\u7f16\u7801\u7684\u6bd2\u529b\u56e0\u5b50\u3001\u94c1\u8f7d\u4f53\u7cfb\u7edf\u548crmpA\u57fa\u56e0\uff0c\u53ef\u5f15\u8d77\u611f\u67d3\u6027\u809d\u8113\u80bf\uff0c\u4f46\u5176\u6bd2\u529b\u8010\u836f\u57fa\u56e0\u7684\u6c34\u5e73\u8f6c\u79fb\u673a\u5236\u5c1a\u672a\u6e05\u695a\u3002\u4e34\u5e8a\u7814\u7a76\u8868\u660e\u9ad8\u6bd2\u529bKp\u2161\u76f8\u5173\u7684\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e(CAP)\u75c5\u6b7b\u7387\u76f8\u5bf9\u8f83\u9ad8\uff0c\u4e00\u682a\u9ad8\u6bd2\u529bKp\u2161\u4e34\u5e8a\u5206\u79bb\u682a\u83cc\u6bdb\u8c03\u63a7\u57fa\u56e0mrkB\u548cmrkC\u4e30\u5ea6\u8f83\u9ad8\uff0c\u4f46\u94c1\u8f7d\u4f53\u7cfb\u7edf\u7f3a\u4e4f\uff0c\u8fd9\u4e0e\u9ad8\u6bd2\u529bKp\u2160\u5b58\u5728\u5dee\u5f02[28]<\/sup>\uff0c\u63a8\u6d4bKp\u2161\u83cc\u682a\u5177\u6709\u72ec\u7acb\u7684\u6bd2\u529b\u8c03\u8282\u7cfb\u7edf\uff0c\u4f46\u6709\u5f85\u7814\u7a76\u3002<\/p>\n

5 Kp\u2162\u7684\u836f\u7269\u654f\u611f\u6027\u3001\u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u60275.1 \u836f\u7269\u654f\u611f\u6027<\/p>\n

Kp\u2162\u83cc\u682a\u5177\u6709\u56fa\u6c2e\u4f5c\u7528\u548c\u4fc3\u8fdb\u690d\u7269\u751f\u957f\u7684\u4f5c\u7528\uff0c\u6816\u606f\u73af\u5883\u591a\u6837\uff0c\u53ef\u5e7f\u6cdb\u5b58\u5728\u4e8e\u690d\u7269\u3001\u6606\u866b\u3001\u52a8\u7269\u3001\u4eba\u4f53\u3001\u571f\u58e4\u3001\u6c34\u548c\u751f\u6001\u73af\u5883\u4e2d[29]<\/sup>\uff0c2004\u5e74\uff0c\u7efc\u5408\u8003\u8651\u83cc\u682a\u57fa\u56e0\u591a\u6001\u6027\u548c\u751f\u6001\u73af\u5883\u591a\u6001\u6027\u5c06Kp\u2162\u547d\u540d\u4e3a\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(K. variicola, Kp\u2162)\u3002\u4e0e\u5176\u4ed6Kp\u83cc\u682a\u4e00\u6837\uff0cKp\u2162\u67d3\u8272\u4f53\u4e0a\u643a\u5e26\u8010\u836f\u57fa\u56e0blaLEN<\/sub>\uff0c\u5bf9\u9752\u9709\u7d20\u7c7b\u5929\u7136\u8010\u836f\u3002\u968f\u7740Kp\u2162\u4ece\u4e34\u5e8a\u548c\u73af\u5883\u4e2d\u5206\u79bb\u7387\u589e\u9ad8\uff0c\u4ea7ESBLs\u548c\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(CRKp\u2162)\u7684\u62a5\u544a\u4e5f\u5728\u589e\u52a0\uff0cKp\u2162\u5728\u73af\u5883\u4e0e\u4e34\u5e8a\u4e4b\u95f4\u4f20\u9012\u8010\u836f\u57fa\u56e0\u7684\u6f5c\u529b\u9010\u6e10\u88ab\u53d1\u73b0\u3002blaCTX-M<\/sub>\u662f\u76ee\u524dESBLs\u57fa\u56e0\u4e2d\u6d41\u884c\u6700\u5e7f\u6cdb\u7684\u7c7b\u578b\uff0c\u4ee5\u5176\u5bf9\u5934\u5b62\u567b\u809f\u7684\u8d85\u5f3a\u6c34\u89e3\u6d3b\u6027\u800c\u5f97\u540d\uff0cFarzana\u7b49[30]<\/sup>\u4ece\u4e00\u682aKp\u2162\u68c0\u51fa\u4e86\u6297\u83cc\u836f\u7269\u8010\u836f\u57fa\u56e0blaNDM-1<\/sub>\u548cblaCTX-M-15<\/sub>\u3002\u968f\u540eESBLs\u57fa\u56e0blaSHV-5<\/sub>\u3001blaSHV-12<\/sub>\u3001blaSHV-30<\/sub>\u7b49\u5747\u4eceKp\u2162\u83cc\u682a\u4e2d\u68c0\u51fa[7]<\/sup>\u3002Kumwenda\u7b49[31]<\/sup>\u4eceCRKp\u2162\u83cc\u682a\u4e2d\u68c0\u6d4b\u5230KPC-2\u548cNDM-1\u578b\u57fa\u56e0\uff0c\u968f\u540e\u62a5\u9053\u4eceCRKp\u2162\u83cc\u682a\u5185\u68c0\u6d4b\u5230NDM-5\u3002Zurfluh\u7b49[32]<\/sup>\u9996\u6b21\u5728\u4ece\u4e9a\u6d32\u8fdb\u53e3\u5230\u745e\u58eb\u7684\u9999\u83dc\u4e2d\u68c0\u6d4b\u5230\u542b\u6709OXA-181\u7684CRKp\u2162\uff0c\u78b3\u9752\u9709\u70ef\u7c7b\u8010\u836f\u57fa\u56e0NDM-9\u3001GES-6\u3001GES-2\u7b49\u5728\u6cb3\u6c34\u6216\u6c61\u6c34\u6765\u6e90\u7684CRKp\u2162\u4e2d\u68c0\u51fa[33]<\/sup>\u3002\u62a5\u9053[7]<\/sup>\u663e\u793a\uff0c\u78b3\u9752\u9709\u70ef\u9176NDM-1\u548c\u03b2-\u5185\u9170\u80fa\u9176CTX-M-15\u4e0e\u53d8\u6816\u514b\u96f7\u4f2f\u83cc\u7684\u9ad8\u8010\u836f\u548c\u9ad8\u6bd2\u529b\u76f8\u5173\u3002\u57282018\u5e74\uff0cGuo\u7b49[34]<\/sup>\u5728\u4e00\u682aKp\u2162-X39\u53d1\u73b0\u4e86\u67d3\u8272\u4f53\u548c\u8d28\u7c92\u7f16\u7801\u7684CTX-M-24\u57fa\u56e0\u3002\u7efc\u4e0a\u6240\u8ff0\uff0cKp\u2162\u83cc\u682a\u7684\u8010\u836f\u73b0\u72b6\u4e0d\u5bb9\u5ffd\u89c6\u3002<\/p>\n

5.2 \u83cc\u682a\u6bd2\u529b\u4e0e\u81f4\u75c5\u6027<\/p>\n

Kp\u2162\u4e0e\u73af\u5883\u5173\u7cfb\u5bc6\u5207\uff0c\u5176\u4e34\u5e8a\u91cd\u8981\u6027\u8d8a\u6765\u8d8a\u51f8\u663e\u30022018\u5e74Dong\u7b49[35]<\/sup>\u7814\u7a76\u8868\u660e\uff0cKp\u2162-X39\u53ef\u5b9a\u690d\u4e8e\u7389\u7c73\u7684\u6839\u3001\u830e\u548c\u53f6\u5e76\u5728\u7279\u5b9a\u6761\u4ef6\u4e0b\u611f\u67d3\u4eba\u81f4\u75c5\u3002\u76ee\u524d\u5df2\u53d1\u73b0\u7684Kp\u2162\u6bd2\u529b\u56e0\u5b50\u4e3b\u8981\u4e3a\u835a\u819c\u3001\u8102\u591a\u7cd6\u3001\u94c1\u8f7d\u4f53\u3001\u83cc\u6bdb\uff0c\u5728\u7ec6\u83cc\u7684\u5165\u4fb5\u3001\u81f4\u75c5\u3001\u514d\u75ab\u9003\u9038\u4e2d\u53d1\u6325\u4f5c\u7528\u30022015\u5e74\u4ece\u4e00\u4f8b\u4f4f\u9662\u7684\u8001\u5e74\u60a3\u8005\u4f53\u5185\u5206\u79bb\u51fa\u7b2c\u4e00\u682a\u9ad8\u6bd2\u529b\u53d8\u6816\u514b\u96f7\u4f2f\u83cc\u682a(hvKp\u2162)\uff0c\u8be5\u83cc\u682a\u57fa\u56e0\u7ec4DNA\u53ef\u68c0\u6d4b\u5230\u7ecf\u5178\u7684\u6bd2\u529b\u56e0\u5b50(\u94c1\u8f7d\u4f53\u3001\u94c1\u6444\u53d6\u7cfb\u7edf\u3001\u83cc\u6bdb\u548c\u9ecf\u9644\u7d20)\uff0c\u57285%\u7f8a\u8840\u7684\u743c\u8102\u5e73\u677f\u4e0a\u62c9\u4e1d\u8bd5\u9a8c\u9633\u6027[6]<\/sup>\u3002\u5206\u79bb\u4e8e\u4e2d\u56fd\u7684\u4e00\u682a\u8840\u57f9\u517b\u6765\u6e90\u7684\u9ecf\u83cc\u7d20\u8010\u836f\u9ad8\u6bd2\u529bKp\u2162 (WCHKV030666)\u4e2d\u68c0\u51fa\u6765\u6e90\u4e8e\u8d28\u7c92\u7684\u9ecf\u6db2\u8868\u578b\u6bd2\u529b\u56e0\u5b50(rmpA\u548crmpA2)\u548c3\u79cd\u8f7d\u4f53\u7cfb\u7edf(yersiniabactin\u3001aerobactin\u548csalmochelin)[35]<\/sup>\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u4e00\u682a\u9ad8\u6bd2\u529b\u9ad8\u8010\u836fKp\u2162\u5e76\u672a\u68c0\u6d4b\u5230\u9ecf\u6db2\u8868\u578b\u6bd2\u529b\u56e0\u5b50(rmpA\u548crmpA2)\uff0c\u4f46\u5176\u81f4\u75c5\u6027\u8fdc\u9ad8\u4e8eST23\u578b\u9ad8\u6bd2\u529b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc[36]<\/sup>\u30022018\u5e74\u6211\u56fd\u56db\u5ddd\u5206\u79bb\u4e86\u4e00\u682a\u8840\u6db2\u6765\u6e90\u7684\u9ad8\u6bd2\u529b\u9ad8\u8010\u836f\u83cc\u682a(WCHKV030666)\uff0c\u540c\u5e74\u5728\u5b5f\u52a0\u62c9\u56fd\u65b0\u751f\u513f\u75c5\u623f\u68c0\u51fa\u4e00\u682a\u66b4\u53d1\u6d41\u884c\u7684\u9ad8\u6bd2\u529b\u591a\u91cd\u8010\u836f\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(ST171)\u5bfc\u81f454.5%\u7684\u65b0\u751f\u513f\u6b7b\u4ea1[29]<\/sup>\u3002\u63a8\u6d4b\u7279\u6b8a\u7684\u9057\u4f20\u80cc\u666f\u3001\u7279\u6b8a\u7684\u6bd2\u529b\u7cfb\u7edf\u53ef\u80fd\u4e0e\u9ad8\u6bd2\u529bKp\u2162\u6bd2\u529b\u7cfb\u7edf\u7684\u5f62\u6210\u76f8\u5173\u3002\u73b0\u6709\u4e34\u5e8a\u6570\u636e\u8868\u660eKp\u2162\u662f\u4e00\u79cd\u673a\u4f1a\u81f4\u75c5\u83cc\uff0c\u53ef\u5f15\u8d77\u8840\u6d41\u76f8\u5173\u611f\u67d3\u3001\u547c\u5438\u7cfb\u7edf\u611f\u67d3\u3001\u65b0\u751f\u513f\u66b4\u53d1\u611f\u67d3\u3001\u539f\u53d1\u6027\u7259\u6839\u7ba1\u611f\u67d3[7]<\/sup>\u3002\u4e34\u5e8a\u4e0a\u5206\u79bb\u7684Kp\u2162\u83cc\u682a70%\u5de6\u53f3\u6765\u81ea\u5c3f\u8def\u76f8\u5173\u611f\u67d3\uff0cKp\u2162\u76f8\u5173\u8840\u6d41\u611f\u67d3\u81f4\u6b7b\u7387\u8f83Kp\u2160\u548cKp\u2161\u9ad8[29]<\/sup>\u3002\u7531\u4e8eKp\u2162\u4e34\u5e8a\u611f\u67d3\u73b0\u72b6\u4e25\u91cd\uff0c\u5728\u611f\u67d3\u7814\u7a76\u4ee5\u53ca\u611f\u67d3\u63a7\u5236\u9886\u57df\u5173\u6ce8\u5ea6\u9010\u6e10\u589e\u9ad8\uff0c\u662f\u4e00\u79cd\u65b0\u53d1\u73b0\u7684\u4eba\u7c7b\u75c5\u539f\u4f53\uff0c\u56e0\u6b64\u83cc\u682a\u7279\u6027\u3001\u6d41\u884c\u75c5\u7279\u5f81\u3001\u81f4\u75c5\u6027\u7814\u7a76\u6709\u52a9\u4e8e\u66f4\u597d\u5730\u63a7\u5236\u611f\u67d3\u6027\u75be\u75c5\u7684\u53d1\u751f\u3002<\/p>\n

6 \u7ed3\u8bed<\/p>\n

Kp\u2161\u548cKp\u2162\u662f\u4eceKp\u4e2d\u5206\u79bb\u51fa\u6765\u7684\u65b0\u7684\u7269\u79cd\uff0c\u53ef\u8ffd\u6eaf\u5230600\u4e07\u5e74\u524d\u3002Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u662f\u4e09\u79cd\u4e0d\u540c\u7684\u7ec6\u83cc\uff0c\u53d7\u4e34\u5e8a\u73b0\u6709\u68c0\u6d4b\u6280\u672f\u7684\u9650\u5236\uff0cKp\u2161\u548cKp\u2162\u4e34\u5e8a\u5206\u79bb\u7387\u8f83\u4f4e\uff0c\u4e34\u5e8a\u62a5\u9053\u8f83\u5c11\u3002Kp\u2160\u3001Kp\u2161\u548cKp\u2162\u5b9a\u690d\u548c\u611f\u67d3\u7684\u6d41\u884c\u75c5\u5b66\u5927\u4e0d\u76f8\u540c\uff0c\u83cc\u682a\u6bd2\u529b\u3001\u8010\u836f\u6027\u53ca\u81f4\u75c5\u7279\u70b9\u5b58\u5728\u5dee\u5f02\uff0c\u89c1\u8868 1\u3002Brisse\u7b49[37]<\/sup>\u7814\u7a76\u53d1\u73b0\uff0cKp\u2160\u8010\u836f\u6027\u6700\u5f3a\uff0cKp\u2161\u6b21\u4e4b\uff0cKp\u2162\u8010\u836f\u6027\u6700\u5f31\u3002Kp\u2160\u662f\u4e34\u5e8a\u5e38\u89c1\u7684\u75c5\u539f\u83cc\uff0c\u5c5e\u673a\u4f1a\u81f4\u75c5\u83cc\uff0c\u53ef\u5f15\u8d77\u793e\u533a\u83b7\u5f97\u6027\u6216\u533b\u9662\u83b7\u5f97\u6027\u611f\u67d3\uff0c\u611f\u67d3\u90e8\u4f4d\u5e7f\u6cdb\uff0c\u643a\u5e26\u6709\u4e30\u5bcc\u7684\u6bd2\u529b\u548c\u8010\u836f\u57fa\u56e0\uff0c\u90e8\u5206\u83cc\u682a\u8868\u73b0\u4e3a\u4ea7ESBLs\u6216\u78b3\u9752\u9709\u70ef\u7c7b\u836f\u7269\u8010\u836f\uff0c\u8010\u836f\u73b0\u72b6\u4e25\u91cd\u3002Kp\u2161\u6700\u5e38\u89c1\u4e8e\u6ccc\u5c3f\u9053\u548c\u547c\u5438\u9053\u611f\u67d3\uff0c\u90e8\u5206\u83cc\u682a\u80fd\u591f\u4ea7ESBLs\uff0c94%\u7684Kp\u2161\u5206\u79bb\u81ea\u4eba\u7c7b\uff0c\u5176\u4e2d50%\u4ee5\u4e0a\u6765\u81ea\u80a0\u9053\u5b9a\u690d\uff0c\u8fdc\u9ad8\u4e8eKp\u2160(24%)\u548cKp\u2162(39%)[24]<\/sup>\u3002\u968f\u7740\u7814\u7a76[38]<\/sup>\u7684\u6df1\u5165\uff0cKp\u2162\u88ab\u5206\u4e3a\u7ecf\u5178\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(cKp\u2162)\u3001\u9ad8\u9ecf\u6db2\u8868\u578b\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(hmvKp\u2162)\u4e0e\u9ad8\u6bd2\u529b\u53d8\u6816\u514b\u96f7\u4f2f\u83cc(hvKp\u2162)\uff0c\u90e8\u5206\u83cc\u682a\u53ef\u4ee5\u5f15\u8d77\u80ba\u708e\u3001\u8840\u6d41\u611f\u67d3\u3001\u8111\u819c\u708e\u3001\u5c3f\u9053\u611f\u67d3\u7b49\uff0cKp\u2162\u76f8\u5173\u8840\u6d41\u611f\u67d3\u81f4\u6b7b\u7387\u8f83Kp\u2160\u548cKp\u2161\u9ad82\u500d\u5de6\u53f3\u3002\u56e0\u5176\u72ec\u7279\u7684\u6bd2\u529b\u8868\u578b\uff0c\u5fae\u751f\u7269\u5b66\u8005Rodr\u00edguez-Medina\u7b49[7]<\/sup>\u8ba4\u4e3aKp\u2162\u662f\u4e00\u79cd\u65b0\u53d1\u73b0\u7684\u4eba\u7c7b\u75c5\u539f\u4f53\uff0c\u5176\u6d41\u884c\u75c5\u7279\u5f81\u4e0e\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u4e0d\u540c\uff0c\u53ef\u80fd\u5b58\u5728\u6709\u72ec\u7acb\u7684\u6bd2\u529b\u7cfb\u7edf\u3002\u56e0\u6b64\uff0cKp\u2160\u3001Kp\u2161\u548cKp\u2162\u7684\u6bd2\u529b\u7279\u5f81\u53ca\u8010\u836f\u6027\u548c\u81f4\u75c5\u6027\u7814\u7a76\u53ef\u4e3a\u611f\u67d3\u7684\u591a\u7ef4\u5ea6\u63a7\u5236\u6a21\u578b\u548c\u63aa\u65bd\uff0c\u4e3a\u6709\u6548\u7684\u76ee\u6807\u6027\u6cbb\u7597\u7b56\u7565\u63d0\u4f9b\u7406\u8bba\u548c\u5b9e\u9a8c\u5ba4\u4f9d\u636e\u3002<\/p>\n<\/p>\n<\/tbody>\n

7 \u5c55\u671b<\/p>\n

Kp\u2160\u3001Kp\u2161\u3001Kp\u2162\u5177\u6709\u4e0d\u540c\u7684\u751f\u6001\u5206\u5e03\uff0cKp\u2161\u3001Kp\u2162\u5177\u6709\u4e0eKp\u2160\u4e0d\u540c\u7684\u6bd2\u529b\u8c03\u8282\u7cfb\u7edf\u548c\u72ec\u7279\u7684\u57fa\u56e0\u5206\u5e03\uff0c\u4e0e\u5176\u8010\u836f\u7279\u70b9\u3001\u83cc\u682a\u81f4\u75c5\u6027\u4e0e\u81f4\u75c5\u80fd\u529b\u5bc6\u5207\u76f8\u5173\u3002\u76f8\u4fe1\u968f\u7740\u57fa\u56e0\u6d4b\u5e8f\u6280\u672f\u7684\u5f00\u5c55\u548c\u666e\u53ca\uff0c\u8d8a\u6765\u8d8a\u591a\u7684Kp\u2161\u3001Kp\u2162\u5c06\u4f1a\u88ab\u9274\u5b9a\u51fa\u6765\uff0c\u5bf9Kp\u2161\u3001Kp\u2162\u7684\u8ba4\u8bc6\u5c06\u4e0d\u65ad\u52a0\u6df1\uff0c\u4fc3\u8fdb\u7cbe\u51c6\u533b\u7597\u548c\u4e2a\u4f53\u5316\u533b\u7597\u7684\u53d1\u5c55\u3002<\/p>\n

\u5f15\u7528\uff1a\u6731\u6631\u84c9, \u5218\u8363\u534e. \u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u3001\u7c7b\u80ba\u708e\u514b\u96f7\u4f2f\u83cc\u548c\u53d8\u6816\u514b\u96f7\u4f2f\u83cc\u7684\u7814\u7a76\u8fdb\u5c55. \u4e2d\u56fd\u611f\u67d3\u63a7\u5236\u6742\u5fd7, 2023, 22(8): 983-989.<\/p>\n","protected":false},"excerpt":{"rendered":"

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