耐碳青霉烯类肠杆菌的流行病学特点与治疗现状

耐碳青霉烯类肠杆菌(carbapenem-resistant Enterobacteriaceae，CRE)是近年来检出率不断升高的一种临床常见耐药菌，是导致患者死亡的独立危险因素。CRE的出现主要是由于细菌产碳青霉烯酶，包括肺炎克雷伯菌产生的碳青霉烯酶(Klebsiella pneumoniae carbapenemase，KPC)、金属β-内酰胺酶(metallo-β-lactamase，MBL)和 苯唑西林酶(oxacillinase，OXA)，少数是由于细菌外膜蛋白改变以及外排泵高表达。临床上最常见的CRE是肺炎克雷伯菌，最常暴发CRE感染的科室是重症监护室(intensive care unit，ICU)，感染高危因素包括接触医疗机构、各种侵入性操作以及抗菌药物使用史。由于缺乏前瞻性临床试验数据，目前在治疗CRE感染的高危患者时多采用多药联合的经验性治疗措施，一些经典药物如多黏菌素、替加环素、磷霉素等起到了意想不到的效果，一些新药如头孢他啶-阿维巴坦也投入使用并发挥了一定作用。本文就近年来CRE感染的流行病学特点以及目前临床上主要使用的药物进行综述。

Epidemiological characteristics and treatment status of carbapenem-resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) is a common clinical drug-resistant bacteria, and its detection rate has been increasing in recent years. CRE infection is an independent risk factor for the death of patients. The emergence of CRE strains is mainly due to the production of carbapenemase including Klebsiella pneumoniae carbapenemase (KPC), metallo-β-lactamase (MBL) and oxacillinase (OXA), and a few are due to the changes in bacterial outer membrane proteins and high expression of efflux pump. The most common clinical CRE is Klebsiella pneumoniae. Intensive care unit (ICU) is the department with the most frequent outbreak of CRE infection. The high-risk factors of CRE infection include the contact with medical institutions, the various invasive procedures, and the history of antibiotic use. Regarding the treatment of CRE infection, due to the lack of data from prospective clinical trials, the empirical multi-drug combination treatment is currently used for high-risk patients. Some “old” drugs such as polymyxin, tigecycline and fosfomycin have played an unexpected effect in the treatment of CRE infection. At the same time, some “new” drugs such as ceftazidime-avibactam have also been put into clinical use and played a certain role. This article reviews the epidemiological characteristics of CRE infection in recent years and the main clinical drugs.