陈君灏;张雯霞;张珏;

• 1:上海中医药大学附属曙光医院检验科

摘要(Abstract)：

肺炎克雷伯菌,因其耐药谱广,耐药率高,其治疗问题已成为世界性难题。中药具有低耐药性、多作用靶位的广谱抗菌效果,因此进行中药治疗或与西药联合治疗是一种对抗多重耐药菌的新型手段。检索近年来中国知网、万方全文和Pubmed等数据库的文献,从肺炎克雷伯的耐药机制和中药抗肺炎克雷伯菌耐药性作用等研究成果,阐述中药复合制剂以及其有效成分在临床上用于治疗肺炎克雷伯菌引起的感染的疗效及作用机制。中药可以通过抑制β-内酰胺酶、对抗生物膜的形成、对抗内毒素的作用以及抑制外排泵等起到抗肺炎克雷伯菌作用。通过对中药的抗菌作用机制进行深入研究,有助于准确全面地评价药效,为今后抗生素的合理选择提供依据。

关键词(KeyWords)： 中药;肺炎克雷伯菌;抗菌机制;综述

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金青年项目(81601801)

作者(Author): 陈君灏;张雯霞;张珏;

Email:

DOI: 10.13463/j.cnki.jlzyy.2020.04.036

参考文献(References)：

• [1]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
• [2]DUCOMBLE T,FAUCHEUX S,HELBIG U,et al.Large hospital outbreak of KPC-2-producing Klebsiella pneumoniae:investigating mortality and the impact of screening for KPC-2 with polymerase chain reaction[J].J Hosp Infect,2015,89(3):179-185.
• [3] KIM J O,SONG S A,YOON E J,et al.Outbreak of KPC-2-producing Enterobacteriaceae caused by clonal dissemination of Klebsiella pneumoniae ST307 carrying an IncX3-type plasmid harboring a truncated Tn4401a[J].Diagn Micr Infec Dis,2017,87(4):343-348.
• [4] YANG J,YE L,GUO L,et al.A nosocomial outbreak of KPC-2-producing Klebsiella pneumoniae in a Chinese hospital:dissemination of ST11 and emergence of ST37,ST392 and ST395[J].Clin Microbiol Infec,2013,19(11):E509-E515.
• [5] LIU J,YU J,CHEN F,et al.Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai,China[J].Eur J Clin Microbiol Infect Dis,2018,37(2):293-299.
• [6]CHEW K L,LIN R T P,TEO J W P.Klebsiella pneumoniae in singapore:hypervirulent infections and the carbapenemase threat[J].Front Cell Infect Microbiol,2017,12(7):1-9.
• [7]KOHLER P P,VOLLING C,GREEN K,et al.Carbapenem resistance,initial antibiotic therapy,and mortality in klebsiella pneumoniae bacteremia:a systematic review and meta-analysis[J].Infect Control Hosp Epidemiol,2017,38(11):1319-1328.
• [8]FALAGAS M E,KARAGEORGOPOULOS D E,NORDMANN P.Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes[J].Future Microbiol,2011,6(6):653-666.
• [9] PATEL G,BONOMO R A.Status report on carbapenemases:challenges and prospects.expert review of anti-infective therapy[J].Expert Rev Anti Infect Ther,2011,9(5):555-570.
• [10] MONACO M,GIANI T,RAFFONE M,et al.Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae:a rapidly evolving problem in Italy,November 2013 to April 2014[J].Euro Surveill,2014,19(42):1-6.
• [11] GUDUCUOGLU H,GURSOY N C,YAKUPOGULLARI Y,et al.Hospital outbreak of a colistin-resistant,NDM-1-and OXA-48-producing klebsiella pneumoniae:high mortality from pandrug resistance[J].Microb Drug Resist,2018,24(7):966-972.
• [12] NORDMANN P,CUZON G,NAAS T.The real threat of klebsiella pneumoniae carbapenemase-producing bacteria[J].Lancet Infect Dis,2009,9(4):228-236.
• [13] BADO I,GUTIERREZ C,GARCIA-FULGUEIRAS V,et al.CTX-M-15 in combination with aac(6’)-Ib-cr is the most prevalent mechanism of resistance both in Escherichia coli and Klebsiella pneumoniae,including K.pneumoniae ST258,in an ICU in Uruguay[J].J Glob Antimicrob Resist,2016,9(6):5-9.
• [14] 梁华,彭小宝,杨军平,等.清开灵、双黄连联合头孢哌酮-舒巴坦钠对产ESBLs肺炎克雷伯菌抗菌作用研究[J].实验与检验医学,2016,34(6):723-727.
• [15] 林青雯,左国营,王根春.九种滇产药用植物体外抗菌作用及其活性部位的初步研究[J].解放军药学学报,2014,30(4):330-333.
• [16] 杨钧,张淑文,阴宏,等.复方清热颗粒剂含药血清对超广谱β-内酰胺酶的抑制作用[J].中国实验方剂学杂志,2007,13(11):40-43.
• [17]KHODADADIAN R,RAHDAR H A,JAVADI A,et al.Detection of VIM-1 and IMP-1 genes in klebsiella pneumoniae and relationship with biofilm formation[J].Microb Pathog,2018,115(12):25-30.
• [18] VUOTTO C,LONGO F,BALICE M P,et al.Antibiotic resistance related to biofilm formation in klebsiella pneumoniae[J].Pathogens,2014,3(3):743-758.
• [19]CHUNG P Y.The emerging problems of klebsiella pneumoniae infections:carbapenem resistance and biofilm formation[J].FEMS Microbiol Lett,2016,363(20):1-6.
• [20] VUOTTO C,LONGO F,PASCOLINI C,et al.Biofilm formation and antibiotic resistance in klebsiella pneumoniae urinary strains[J].J Appl Microbiol,2017,123(4):1003-1018.
• [21] RAJASEKHARAN S K,RAMESH S,SATISH A S,et al.Antibiofilm and anti-beta-lactamase activities of burdock root extract and chlorogenic acid against klebsiella pneumoniae[J].J Microbiol Biotechnol,2017,27(3):542-551.
• [22]黎勇强,张颖嫦.绿原酸联合左氧氟沙星对肺炎克雷伯菌生物膜的体外抑制现象观察与探讨[J].黑龙江医药,2018,31(3):535-537.
• [23] 殷姿,欧宜文,李蓓,等.黄芩对肺炎克雷伯菌抑制作用及其机制研究[J].中国病原生物学杂志,2016,11(5):388-392.
• [24] GOPU V,KOTHANDAPANI S,SHETTY P H.Quorum quenching activity of syzygium cumini (L.) skeels and its anthocyanin malvidin against klebsiella pneumoniae[J].Microb Pathog,2015,79:61-69.
• [25]BILCU M,GRUMEZESCU A M,OPREA A E,et al.Efficiency of vanilla,patchouli and ylang ylang essential oils stabilized by iron oxide@C14 nanostructures against bacterial adherence and biofilms formed by Staphylococcus aureus and Klebsiella pneumoniae clinical strains[J].Molecules,2014,19(11):17943-17956.
• [26]丘岳,黄振光,黄晓青,等.肺感方及其联合头孢噻肟对肺炎克雷伯菌生物被膜的体外干预作用[J].广西医学,2017,39(1):65-68.
• [27]温桃群,王学,王凤,等.中药复方治疗内毒素性肺损伤的研究进展[J].中国民族民间医药,2017,26(4):64-71.
• [28] 万启南,韦衮政,李黔云,等.清热解毒扶正颗粒对内毒素大鼠肺肾组织NF-κB p65蛋白的影响[J].云南中医中药杂志,2017,38(5):16-20.
• [29] 陶梦婕,王刚,肖湘香.三七皂苷对SD大鼠全身炎症反应综合征炎性细胞因子的影响[J].内蒙古中医药,2018,37(5):95-96.
• [30]卢滔,方敏,彭春仙,等.产KPC酶肺炎克雷伯菌的感染分布特点及中西医药物结合对其的抑制效果[J].中国现代医生,2018,56(3):15-18.
• [31] 钟海琴,张顺,蔡挺.连翘酯苷B对肺炎克雷伯菌外排泵活性的影响[J].中国新药与临床杂志,2013,32(4):303-306.