New Advances in the Mechanisms of Colistin Resistance in <i>Klebsiella pneumoniae</i>

全球范围内细菌耐药性的上升给临床诊疗带来了挑战。碳青霉烯耐药肺炎克雷伯菌(CRKP)的流行使得医院获得性感染率增加，对患者的治疗方案变得有限，同时增加了住院时间、死亡率和费用。多黏菌素则重新回到了临床，成为对抗革兰阴性多重耐药菌的最后一道防线。不幸的是，全球范围内陆续出现多黏菌素耐药的肺炎克雷伯菌。本文综述了肺炎克雷伯菌耐药机制的新进展，包括染色体介导的耐药机制和质粒介导的耐药机制。此外，本文还探讨了异质性耐药、生物膜屏障效应等新发现的耐药机制。通过系统分析近年研究，本文旨在为肺炎克雷伯菌多黏菌素耐药机制解析和新型抗感染策略开发提供理论依据。The increasing prevalence of bacterial drug resistance worldwide has posed significant challenges to clinical diagnosis and treatment. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has led to an increase in hospital-acquired infection rates, limited treatment options for patients, and increased hospital stays, mortality, and costs. Colistin has re-emerged in the clinical setting as the last line of defense against multidrug-resistant Gram-negative bacteria. Unfortunately, strains of colistin-resistant K. pneumoniae have been reported globally. This review summarizes the latest progress in the resistance mechanisms of K. pneumoniae, including chromosomally mediated resistance mechanisms and plasmid-mediated resistance mechanisms. Additionally, this article discusses newly discovered resistance mechanisms such as heterogeneous resistance and biofilm barrier effects. By systematically analyzing recent studies, this review aims to provide a theoretical basis for the elucidation of colistin resistance mechanisms in K. pneumoniae and the development of novel anti-infective strategies.