Abstract：
The evolution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae can be categorized into three main patterns: the evolution of KL1/KL2-hvKp strains into CR-hvKp, the evolution of carbapenem-resistant K. pneumoniae (CRKp) strains into hv-CRKp, and the acquisition of hybrid plasmids carrying carbapenem resistance and virulence genes by classical K. pneumoniae (cKp). These strains are characterized by multi-drug resistance, high virulence, and high infectivity. Currently, there are no effective methods for treating and surveillance this pathogen. In addition, the continuous horizontal transfer and clonal spread of these bacteria under the pressure of hospital antibiotics have led to the emergence of more drug-resistant strains. This review discusses the evolution and distribution characteristics of hypervirulent and carbapenem-resistant K. pneumoniae, the mechanisms of carbapenem resistance and hypervirulence, risk factors for susceptibility, infection syndromes, treatment regimens, real-time surveillance and preventive control measures. It also outlines the resistance mechanisms of antimicrobial drugs used to treat this pathogen, providing insights for developing new drugs, combination therapies, and a \"One Health\" approach. Narrowing the scope of surveillance but intensifying implementation efforts is a viable solution. Monitoring of strains can be focused primarily on hospitals and urban wastewater treatment plants.
摘要：
高毒力和耐碳青霉烯类肺炎克雷伯菌的进化可分为三种主要模式：KL1/KL2-hvKp菌株进化为CR-hvKp，耐碳青霉烯类肺炎克雷伯菌（CRKp）菌株向hv-CRKp的演变，以及经典肺炎克雷伯菌（cKp）获得携带碳青霉烯抗性和毒力基因的杂交质粒。这些菌株的特点是多药耐药性，高毒力,和高传染性。目前,没有有效的方法来治疗和监测这种病原体。此外,这些细菌在医院抗生素的压力下不断的水平转移和克隆传播导致了更多的耐药菌株的出现。这篇综述讨论了高毒力和耐碳青霉烯类肺炎克雷伯菌的进化和分布特征，碳青霉烯耐药和高毒力的机制，易感性的危险因素，感染综合征，治疗方案,实时监测和预防控制措施。它还概述了用于治疗这种病原体的抗菌药物的耐药机制，为开发新药提供见解，联合疗法,和“一个健康”的方法。缩小监测范围但加大执行力度是可行的解决办法。菌株的监测可以主要集中在医院和城市污水处理厂。
