{"id":1015,"date":"2017-04-06T21:43:42","date_gmt":"2017-04-06T19:43:42","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/04\/06\/vyskyt-kmenov-streptococcus-pneumoniae-pri-zapalovych-ochoreniach-hornych-dychacich-ciest-deti-v-predskolskom-veku-a-ich-rezistencia-na-antibiotika\/"},"modified":"2017-10-03T08:02:54","modified_gmt":"2017-10-03T06:02:54","slug":"prevalence-of-streptococcus-pneumoniae-phyla-in-inflammatory-diseases-of-upper-airways-in-preschool-age-children-and-their-resistance-to-antibiotics","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/prevalence-of-streptococcus-pneumoniae-phyla-in-inflammatory-diseases-of-upper-airways-in-preschool-age-children-and-their-resistance-to-antibiotics\/","title":{"rendered":"Prevalence of Streptococcus pneumoniae phyla in inflammatory diseases of upper airways in preschool age children and their resistance to antibiotics"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*V\u0161etky tabu\u013eky, grafy a obr\u00e1zky, ktor\u00e9 s\u00fa s\u00fa\u010das\u0165ou \u010dl\u00e1nku, n\u00e1jdete v prilo\u017eenom \r\nPDF s\u00fabore na konci \u0161t\u00fadie.\r\n\r\n<\/span><\/strong><\/pre>\n<p><strong>\u00davod<\/strong><\/p>\n<p><em>S. pneumoniae <\/em>je bakt\u00e9ria ktor\u00e1 \u00a0\u010dasto os\u00edd\u013euje \u00a0sliznice horn\u00fdch \u00a0d\u00fdchac\u00edch ciest. Z asymptomatickej koloniz\u00e1cie sa v\u0161ak m\u00f4\u017ee \u00a0vyvin\u00fa\u0165 ochorenie d\u00fdchac\u00edch ciest \u00a0ale aj invaz\u00edvna infekcia. Nazofaryng\u00e1lne nosi\u010dstvo pneumokokov je \u010dastej\u0161ie \u00a0u mal\u00fdch \u00a0det\u00ed, ktor\u00e9 \u00a0s\u00fa rezervo\u00e1rom a vektorom tejto\u00a0bakt\u00e9rie pri jej horizont\u00e1lnom \u0161\u00edren\u00ed v komunite. Koloniz\u00e1cia sliznice nazofaryngu potenci\u00e1lne patog\u00e9nnymi bakt\u00e9riami je dynamick\u00fd proces ovplyvnen\u00fd najm\u00e4 stavom lok\u00e1lnej slizni\u010dnej imunity, ale je podmienen\u00fd aj vekom, genetick\u00fdmi a socioekonomick\u00fdmi faktormi. Nosi\u010dstvo pneumokokov v ekonomicky vyspel\u00fdch \u0161t\u00e1toch rastie s vekom. Vo F\u00ednsku Syrjanen\u00a0a kol.(1) \u00a0zaznamenali v\u00fdskyt <em>S. pneumoniae <\/em>u 13 % det\u00ed \u00a0do\u00a06 mesiacov a u 43 % det\u00ed vo veku nad 19 mesiacov. Zo socio-ekonomick\u00fdch a environment\u00e1lnych faktorov \u00a0na frekvenciu koloniz\u00e1cie vpl\u00fdva najm\u00e4 ve\u013ekos\u0165 rodiny, po\u010det s\u00farodencov, pr\u00edjem rodiny, faj\u010denie a u\u017e\u00edvanie antibiot\u00edk. Pri koloniz\u00e1cii m\u00e1 d\u00f4le\u017eit\u00fa \u00falohu ekosyst\u00e9m sliznice a vz\u00e1jomn\u00e9 interakcie medzi mikroorganizmami na sliznici horn\u00fdch\u00a0 d\u00fdchac\u00edch ciest(2). Je zn\u00e1me, \u017ee v\u00edrusov\u00e1 infekcia zvy\u0161uje predispoz\u00edciu na bakteri\u00e1lnu superinfekciu napr. pri chr\u00edpke \u00a0b\u00fdva \u0165a\u017ekou \u00a0komplik\u00e1ciou \u00a0pneumokokov\u00e1 pneum\u00f3nia(3). Nielen pri chr\u00edpke, \u00a0ale v\u0161eobecne pri infekci\u00e1ch sp\u00f4soben\u00fdch respira\u010dn\u00fdmi v\u00edrusmi, ako napr. \u00a0rinov\u00edrus, metapneumov\u00edrus, RSV, adenov\u00edrus, koronav\u00edrusy je vy\u0161\u0161ia \u00a0predispoz\u00edcia k bakteri\u00e1lnej superinfekcii v d\u00f4sledku naru\u0161enia epitelovej \u00a0bari\u00e9ry v\u00edrusom, \u00a0pre zv\u00fd\u0161enie expresie adhez\u00edvnych prote\u00ednov via\u017eucich potenci\u00e1lne patog\u00e9nne bakt\u00e9rie, \u00a0a pre naru\u0161enie funkcie neutrofilov, NK buniek \u00a0a monocytov(3). Interakcie medzi naj\u010dastej\u0161\u00edmi podmienen\u00fdmi patog\u00e9nmi \u00a0kolonizuj\u00facimi horn\u00e9 \u00a0d\u00fdchacie cesty <em>S. pneumoniae, Haemophilus influenzae, Moraxella catarrha<\/em><em>lis <\/em>a <em>Staphylococcus aureus <\/em>boli dok\u00e1zan\u00e9 aj v experiment\u00e1lnych podmienkach(4). <em>S. pneumoniae <\/em>je mohutn\u00fdm producentom peroxidu vod\u00edka. Ten p\u00f4sob\u00ed bakteric\u00eddne aj na bakt\u00e9rie produkuj\u00face katal\u00e1zu (<em>S. aureus, H. influenzae<\/em>), enz\u00fdm, ktor\u00fd rozklad\u00e1 peroxid \u00a0vod\u00edka(5,6). \u00a0In\u00fdm mechanizmom vz\u00e1jomnej interferencie medzi \u00a0<em>S. pneumoniae <\/em>a <em>H. influenzae <\/em>je p\u00f4sobenie \u00a0pneumokokovej neuraminid\u00e1zy na povrchov\u00e9 sialov\u00e9 kyseliny\u00a0 <em>H. influenzae<\/em>, \u010d\u00edm \u00a0sa zabr\u00e1ni adherencii hemofila k sliznici(7). Pravdepodobne najpriaznivej\u0161ie vz\u0165ahy s\u00fa medzi <em>S. pneumoniae <\/em>a <em>M. catarrhalis. \u00a0<\/em>Perez \u00a0a kol. v roku 2014(8) v \u0161t\u00fadii vz\u0165ahov <em>S. pneumoniae <\/em>a <em>M. catarrhalis <\/em>v biofilmoch zistili, \u017ee v pr\u00edtomnosti <em>S. pneumoniae <\/em>doch\u00e1dza k mno\u017eeniu kult\u00fary <em>M. catarrhalis. <\/em>Tento fenom\u00e9n je sprostredkovan\u00fd sign\u00e1lnou \u00a0molekulou Al-2. <em>M. catarrhalis \u00a0<\/em>svojou betalaktam\u00e1zou poskytuje pas\u00edvnu ochranu pneumokokom proti betalakt\u00e1mov\u00fdm antibiotik\u00e1m, preto je n\u00e1ro\u010dnej\u0161ia lie\u010dba koinfekci\u00ed t\u00fdchto dvoch \u00a0mikroorganizmov. <em>S. pneumoniae <\/em>je bakt\u00e9ria, ktor\u00e1 v posledn\u00fdch \u0161tyridsiatich rokoch sa zaradila medzi terapeuticky problematick\u00e9 mikroorganizmy pre\u00a0 \u010dast\u00fa multirezistenciu na antibiotik\u00e1. T\u00e1to nepriazniv\u00e1 vlastnos\u0165 je d\u00f4sledkom jej schopnosti rozpozna\u0165, absorbova\u0165 a integrova\u0165 extracelul\u00e1rne polydeoxynukleotidy do svojich \u0161truktur\u00e1lnych g\u00e9nov. Pr\u00edtomnos\u0165 dlh\u00fdch cudz\u00edch DNA sekvenci\u00ed v g\u00e9noch pre prote\u00edny via\u017euce penicil\u00edn (PBP), tzv. mozaicizmus, sp\u00f4sobuje polymorfizmus prote\u00ednov PBP, ich zn\u00ed\u017een\u00fa afinitu k penicil\u00ednu a zmenen\u00fa \u0161trukt\u00faru bakt\u00e9ri\u00ed rezistentn\u00fdch na peptidoglyk\u00e1n. <em>S. pneumoniae <\/em>z\u00edskava cudzie DNA sekvencie podmie\u0148uj\u00face zn\u00ed\u017een\u00fa citlivos\u0165 a\u017e rezistenciu na penicil\u00edn od alfahemolytick\u00fdch streptokokov kolonizuj\u00facich horn\u00e9 d\u00fdchacie cesty. Kmene rezistentn\u00e9 na penicil\u00edn s\u00fa \u010dasto nosite\u013emi rezistencie aj na \u010fal\u0161ie skupiny antibiot\u00edk, ako s\u00fa makrolidy, linkozamidy, tetracykl\u00edny, kotrimoxazol. Pneumokoky z\u00edskavaj\u00fa g\u00e9ny rezistencie aj od in\u00fdch grampozit\u00edvnych (napr. stafylokoky, enterokoky) alebo od gramnegat\u00edvnych bakt\u00e9ri\u00ed (napr. <em>E. coli<\/em>, <em>Klebsiella spp.<\/em>, <em>Neisseria spp<\/em>., <em>Haemophilus <\/em><em>spp<\/em>.)(9).<\/p>\n<p>Cie\u013eom \u00a0tejto \u00a0publik\u00e1cie je \u00a0monitorova\u0165 v\u00fdskyt \u00a0kme\u0148ov <em>S. pneumoniae <\/em>vo v\u00fdteroch z tonz\u00edl a z nosa u det\u00ed do 5 rokov pri ak\u00fatnych z\u00e1paloch horn\u00fdch d\u00fdchac\u00edch ciest \u00a0vo vybran\u00fdch regi\u00f3noch Slovenska, zisti\u0165 jeho koincidenciu s in\u00fdmi patog\u00e9nmi \u00a0alebo \u00a0potenci\u00e1lnymi \u00a0patog\u00e9nmi \u00a0horn\u00fdch \u00a0d\u00fdchac\u00edch ciest a prezentova\u0165 aktu\u00e1lny \u00a0stav ich citlivosti \u00a0na testovan\u00e9 antibiotik\u00e1 pod\u013ea krit\u00e9ri\u00ed normy EUCAST.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Materi\u00e1l a metodika<\/strong><\/p>\n<p>Do s\u00faboru sme zaradili \u00a0v\u00fdtery z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest det\u00ed \u00a0do \u00a05 rokov veku \u00a0s diagn\u00f3zami ak\u00fatneho z\u00e1palu horn\u00fdch \u00a0d\u00fdchac\u00edch ciest, odobrat\u00e9 v obdob\u00ed od 1. 3. 2014 \u00a0do\u00a031. 3. 2015. V\u00fdtery z tonz\u00edl a z nosa odobrali o\u0161etruj\u00faci lek\u00e1ri na\u00a0 detoxikovan\u00fd tamp\u00f3n v transportnom m\u00e9diu \u00a0pod\u013ea Amiesa s akt\u00edvnym uhl\u00edm, ktor\u00e9 \u00a0boli transportovan\u00e9 pri teplote 20 a\u017e 25 \u00b0C do laborat\u00f3ri\u00ed HPL spol. \u00a0s r. o. v Kom\u00e1rne, Leviciach,\u00a0 Galante, \u00a0Topo\u013e\u010danoch, Pre\u0161ove, Ko\u0161iciach a Bratislave-Petr\u017ealke. Vzorky poch\u00e1dzali od 115 \u00a0804 \u00a0pacientov z 13 okresov Z\u00e1padn\u00e9ho Slovenska (Kom\u00e1rno, Levice, Nitra, Nov\u00e9 Z\u00e1mky, \u0160a\u013ea, Topo\u013e\u010dany, Zlat\u00e9 \u00a0Moravce, Dunajsk\u00e1 Streda, \u00a0Partiz\u00e1nske, Galanta, \u00a0B\u00e1novce nad Bebravou, \u00a0Pezinok, Bratislava V) a zo 7 okresov V\u00fdchodn\u00e9ho Slovenska (Ko\u0161ice, Michalovce, \u00a0Trebi\u0161ov, Pre\u0161ov, Snina, Humenn\u00e9, Sabinov). \u00a0V\u00fdtery boli inokulovan\u00e9 na\u00a0 krvn\u00fd agar Columbia \u00a0so 7 % baranej krvi a boli inkubovan\u00e9 18 a\u017e 20 hod\u00edn\u00a0 pri teplote 35 \u00b0C v mikroaerofilnom prostred\u00ed s 5 % CO2. Suspektn\u00e9 kol\u00f3nie \u00a0<em>S. pneumoniae <\/em>boli overen\u00e9 testom citlivosti na optoch\u00edn \u00a0(5 ug) a bola stanoven\u00e1 ich citlivos\u0165 na zostavu antibiot\u00edk \u2013 oxacil\u00edn (skr\u00edningov\u00fd disk), erytromyc\u00edn, klindamyc\u00edn, ofloxac\u00edn, tetracykl\u00edn, kotrimoxazol \u2013 diskovou dif\u00faznou \u00a0met\u00f3dou pod\u013ea pravidiel normy EUCAST(10,11). Na testovanie citlivosti bol pou\u017eit\u00fd agar pod\u013ea Muellera a Hintonovej s 5 % konskej krvi a s NAD (MHF), na ktor\u00fa bolo rovnomerne v troch na \u00a0seba kolm\u00fdch \u00a0smeroch nao\u010dkovan\u00e9 inokulum \u00a0<em>S. pneu<\/em><em>moniae <\/em>s hustotou 0,5 McF. Disky s po\u017eadovanou koncentr\u00e1ciou antibiot\u00edk \u00a0boli umiestnen\u00e9 na povrch nao\u010dkovan\u00e9ho kultiva\u010dn\u00e9ho m\u00e9dia \u00a0a n\u00e1sledne boli inkubovan\u00e9 v termostate s 5 % CO2 pri teplote 35 \u00b0C 18 a\u017e 20 hod\u00edn. Citlivos\u0165 na penicil\u00edn a amoxicil\u00edn bola hodnoten\u00e1 na z\u00e1klade skr\u00edningov\u00e9ho testu betalakt\u00e1movej rezistencie <em>S. pneumoniae <\/em>skr\u00edningov\u00fdm diskom s obsahom 1 ug oxacil\u00ednu \u00a0v s\u00falade s normou EUCAST(10,11). V pr\u00edpade, \u00a0\u017ee inhibi\u010dn\u00e1 \u00a0z\u00f3na \u00a0okolo \u00a0skr\u00edningov\u00e9ho disku bola \u00a0\u2265 20 mm, testovan\u00fd kme\u0148 \u00a0<em>S. pneumoniae <\/em>bol hodnoten\u00fd ako citliv\u00fd na\u00a0 penicil\u00edn \u00a0a amoxicil\u00edn. \u00a0Pri ve\u013ekosti inhibi\u010dnej z\u00f3ny \u00a01 ug oxacil\u00ednu &lt; 20 mm, \u00a0ale \u00a0z\u00e1rove\u0148 \u2265 8 mm \u00a0je peror\u00e1lny fenoxymetylpenicil\u00edn v lie\u010dbe \u00a0klinicky ne\u00fa\u010dinn\u00fd, \u00a0testovan\u00fd kme\u0148 \u00a0bol \u00a0hodnoten\u00fd ako \u00a0rezistentn\u00fd na penicil\u00edn a citliv\u00fd na amoxicil\u00edn. \u00a0Pri ve\u013ekosti inhibi\u010dnej z\u00f3ny 1 ug oxacil\u00ednov\u00e9ho disku \u00a0&lt; 8 mm, pou\u017eitie \u00a0betalakt\u00e1mov\u00e9ho \u00a0antibiotika v lie\u010dbe je mo\u017en\u00e9 len na z\u00e1klade v\u00fdsledku kvantitat\u00edvnej citlivosti \u2013 MIC. Ke\u010f\u017ee n\u00e1\u0161 s\u00fabor tvorili ambulantn\u00ed \u00a0pacienti v detskom veku, u ktor\u00fdch s\u00fa betalakt\u00e1mov\u00e9 antibiotik\u00e1 pri infekci\u00e1ch horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0liekmi vo\u013eby, na s\u00fabore 100 \u00a0pacientov, z toho \u00a085 pacientov s mas\u00edvnym a 15 pacientov so stredne mas\u00edvnym n\u00e1lezom kme\u0148a S. pneumoniae v skr\u00edningovom teste so \u00a0z\u00f3nou \u00a0oxacil\u00ednu\u00a0&lt; 8 mm \u00a0a z\u00e1rove\u0148 rezistentn\u00fdm na makrolidov\u00e9, linkozamidov\u00e9 antibiotik\u00e1 a kotrimoxazol sme stanovili MIC ampicil\u00ednu (amoxicil\u00ednu) antibiotika, ktor\u00e9 prich\u00e1dza do \u00favahy v peror\u00e1lnej lie\u010dbe. \u00a0Kvantitat\u00edvnu \u00a0citlivos\u0165 t\u00fdchto \u00a0kme\u0148ov \u00a0na ampicil\u00edn (amoxicil\u00edn) sme stanovili \u00a0pomocou E-testu. \u00a0Suspenziu testovan\u00e9ho kme\u0148a s hustotou 0,5 McF sme naniesli na povrch kultiva\u010dn\u00e9ho m\u00e9dia \u00a0MHF tak, ako pri diskovej \u00a0dif\u00faznej met\u00f3de, s n\u00e1sledn\u00fdm ulo\u017een\u00edm pr\u00fa\u017eku E-testu obsahuj\u00facim\u00a0gradient koncentr\u00e1ci\u00ed testovan\u00e9ho antibiotika ampicil\u00ednu. Takto pripraven\u00fa p\u00f4du \u00a0s E-testom sme inkubovali \u00a018 a\u017e 20 hod\u00edn \u00a0pri teplote 35 \u00b0C v prostred\u00ed 5 % CO2 a n\u00e1sledne sme od\u010d\u00edtali \u00a0hodnotu minim\u00e1lnej inhibi\u010dnej \u00a0koncentr\u00e1cie (MIC) pod\u013ea odpor\u00fa\u010dan\u00ed v\u00fdrobcu(20).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>\u00fdsledky<\/strong><\/p>\n<p>Za sledovan\u00e9 obdobie bolo \u00a0v\u00a0\u00a0 uveden\u00fdch laborat\u00f3riach HPL spol. s r. o. analyzovan\u00fdch spolu \u00a0115 804 v\u00fdterov z horn\u00fdch d\u00fdchac\u00edch ciest \u00a0od det\u00ed vo veku do 5 rokov. Tieto tvorili 50,76 % v\u0161etk\u00fdch v\u00fdterov z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0odobrat\u00fdch od pacientov do veku 18 rokov. V <strong><em>tabu\u013eke 1 <\/em><\/strong>a na <strong><em>grafe 1 <\/em><\/strong>uv\u00e1dzame po\u010det a percentu\u00e1lny podiel v\u00fdterov z horn\u00fdch d\u00fdchac\u00edch ciest \u00a0s n\u00e1lezom <em>S. pneumoniae <\/em>u det\u00ed do 5 rokov veku v regi\u00f3noch jednotliv\u00fdch pracov\u00edsk HPL spol. \u00a0s r. o. Na porovnanie v <strong><em>tabu\u013eke 2 <\/em><\/strong>uv\u00e1dzame po\u010det a percentu\u00e1lny podiel n\u00e1lezov \u00a0<em>S. pneumoniae <\/em>v ostatnej \u010dasti detskej popul\u00e1cie (vek 6 a\u017e 18 rokov).<\/p>\n<p>Najvy\u0161\u0161\u00ed podiel <em>S. pneumoniae <\/em>u det\u00ed do 5 rokov veku sme zaznamenali v regi\u00f3ne laborat\u00f3ria v Topo\u013e\u010danoch (14,09 %) a najni\u017e\u0161\u00ed \u00a0v regi\u00f3ne laborat\u00f3ria v Kom\u00e1rne \u00a0(6,81 %). V\u00fdskyt <em>S. pneumoniae <\/em>u det\u00ed star\u0161\u00edch ako 5 rokov bol vo v\u0161etk\u00fdch regi\u00f3noch v\u00fdrazne ni\u017e\u0161\u00ed ako u det\u00ed do 5 rokov veku.<\/p>\n<p>Najviac kme\u0148ov \u00a0<em>S. pneumoniae <\/em>bolo izolovan\u00fdch v regi\u00f3ne laborat\u00f3ria v Bratislave-Petr\u017ealke a v pre\u0161ovskom regi\u00f3ne <strong><em>(graf 1)<\/em><\/strong>.<\/p>\n<p>Po\u010det a percentu\u00e1lny podiel n\u00e1lezov <em>S. pneumoniae <\/em>v jednotliv\u00fdch \u00a0vekov\u00fdch kateg\u00f3ri\u00e1ch det\u00ed \u00a0do 5 rokov zn\u00e1zor\u0148uje <strong><em>tabu\u013eka 3 a graf 2<\/em><\/strong>.<\/p>\n<p>V\u00fdskyt <em>S. pneumoniae <\/em>pri infekci\u00e1ch horn\u00fdch \u00a0d\u00fdchac\u00edch ciest v sledovanej vekovej \u00a0kateg\u00f3rii det\u00ed \u00a0do\u00a0 5 rokov rastie s vekom s najvy\u0161\u0161\u00edm v\u00fdskytom v skupine 3- a\u017e 5-ro\u010dn\u00fdch. V\u00fdnimkou\u00a0 je pre\u0161ovsk\u00fd regi\u00f3n, kde sme zaznamenali vy\u0161\u0161\u00ed v\u00fdskyt tejto bakt\u00e9rie v skupin\u00e1ch det\u00ed do 1 roka a u 1- a\u017e 3-ro\u010dn\u00fdch.<\/p>\n<p>Zauj\u00edmala n\u00e1s aj koincidencia <em>S. pneumoniae <\/em>s \u010fal\u0161\u00edmi potenci\u00e1lne alebo prim\u00e1rne patog\u00e9nnymi bakt\u00e9riami pri z\u00e1paloch horn\u00fdch d\u00fdchac\u00edch ciest \u00a0u det\u00ed do 5 rokov. Preh\u013ead t\u00fdchto n\u00e1lezov uv\u00e1dzame v <strong><em>tabu\u013eke 4<\/em><\/strong>.<\/p>\n<p>Naj\u010dastej\u0161\u00ed bol s\u00fa\u010dasn\u00fd n\u00e1lez \u00a0<em>S. pneumoniae <\/em>a <em>M. catarr<\/em><em>halis <\/em>(24,47 %), <em>S. pneumoniae <\/em>s <em>H. influenzae <\/em>sa vyskytovali spolu \u00a0u 8,02 % pacientov a s\u00fa\u010dasn\u00fd n\u00e1lez \u00a0<em>S. pneumoniae <\/em>a <em>S. aureus <\/em>sme zaznamenali u 5,01 % pacientov. S\u00fa\u010dasn\u00fd v\u00fdskyt s in\u00fdmi podmienen\u00fdmi patog\u00e9nmi, resp. prim\u00e1rnymi\u00a0 patog\u00e9nmi horn\u00fdch d\u00fdchac\u00edch ciest \u00a0sme zaznamenali iba ojedinele.<\/p>\n<p>Preh\u013ead \u00a0rezistencie kme\u0148ov \u00a0<em>S. pneumoniae <\/em>izolovan\u00fdch zo vzoriek horn\u00fdch d\u00fdchac\u00edch ciest det\u00ed do 5 rokov pri z\u00e1palov\u00fdch ochoreniach horn\u00fdch d\u00fdchac\u00edch ciest na testovan\u00e9 anti- mikrobi\u00e1lne l\u00e1tky uv\u00e1dzame v <strong><em>tabu\u013eke 5<\/em><\/strong>.<\/p>\n<p>V na\u0161om s\u00fabore bolo 14 a\u017e 41 % kme\u0148ov \u00a0<em>S. pneumoniae <\/em>necitliv\u00fdch \u00a0na fenoxymetilpenicil\u00edn. V rezistencii na toto \u00a0antibiotikum\u00a0 sme zaznamenali v\u00fdrazn\u00fd geografick\u00fd rozdiel. Vo v\u00e4\u010d\u0161ine regi\u00f3nov z\u00e1padn\u00e9ho Slovenska bola t\u00e1to rezistencia okolo 20 %, s v\u00fdnimkou regi\u00f3nu \u00a0laborat\u00f3ria v Topo\u013e\u010danoch, kde \u00a0bol podiel kme\u0148ov \u00a0necitliv\u00fdch \u00a0na \u00a0fenoxymetylpenicil\u00ed 36 %. Na v\u00fdchodnom Slovensku bola miera necitlivosti kme\u0148ov <em>S. pneumoniae <\/em>na fenoxymetylpenicil\u00edn v pre\u0161ovskom regi\u00f3ne \u00a041 %. Rezistencia na makrolidov\u00e9 antibiotik\u00e1 sa v na\u0161om \u00a0s\u00fabore pohybovala od 23 do 44 % a na linkozamidy \u00a0od 14 do 33 %. Rezistencia na kotrimoxazol sa v na\u0161om s\u00fabore vyskytovala od 11 do 32 %. V pr\u00edpade 100 vybran\u00fdch kme\u0148ov <em>S. pneumoniae <\/em>s rezistenciou na\u00a0 erytromyc\u00edn, \u00a0klindamyc\u00edn, kotrimoxazol a \u00a0s v\u00fdsledkom skr\u00edningov\u00e9ho testu betalakt\u00e1movej rezistencie sved\u010diaceho o nevhodnosti fenoxymetylpenicil\u00ednu \u00a0v lie\u010dbe sme vykonali kvantitat\u00edvne stanovenie citlivosti \u00a0na ampicil\u00edn \u00a0(amoxicil\u00edn) \u00a0E-testom. Na z\u00e1klade v\u00fdsledku E-testu\u00a0 bolo 57 % testovan\u00fdch kme\u0148ov \u00a0rezistentn\u00fdch (MIC &gt; 2 mg\/l) \u00a0na ampicil\u00edn (amoxicil\u00edn), 34% intermedi\u00e1rne citliv\u00fdch (MIC &gt; 0,5 \u2264 2 mg\/l) \u00a0a iba 9 % testovan\u00fdch kme\u0148ov vykazovalo \u00a0citlivos\u0165 (MIC \u2264 0,5 mg\/l) \u00a0na ampicil\u00edn (amoxicil\u00edn) pod\u013ea interpreta\u010dn\u00fdch krit\u00e9ri\u00ed normy EUCAST(10,11).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Diskusia<\/strong><\/p>\n<p>Nazofaryng\u00e1lne nosi\u010dstvo <em>St<\/em><em>r<\/em><em>ep<\/em><em>t<\/em><em>ococcu<\/em><em>s pneumoniae <\/em>je hlavn\u00fdm faktorom \u0161\u00edrenia tejto bakt\u00e9rie v popul\u00e1cii. Preh\u013eadn\u00e9 \u0161t\u00fadie venuj\u00face sa zmapovaniu v\u00fdskytu tejto bakt\u00e9rie v popul\u00e1cii det\u00ed boli vykon\u00e1van\u00e9 najm\u00e4 pred zaveden\u00edm o\u010dkovania proti tejto bakt\u00e9rii s cie\u013eom zisti\u0165 prevalenciu s\u00e9rotypov v popul\u00e1cii. \u00a0V na\u0161ej \u0161t\u00fadii \u00a0sme sledovali \u00a0v\u00fdskyt <em>S. pneumoniae <\/em>u det\u00ed do 5 rokov s pr\u00edznakmi infekcie horn\u00fdch d\u00fdchac\u00edch ciest na po\u010detnom s\u00fabore 115 804 pacientov. Ke\u010f\u017ee s\u00e9rotypiz\u00e1cia kme\u0148ov <em>S. pneumoniae <\/em>nie je s\u00fa\u010das\u0165ou rutinnej mikrobiologickej diagnostiky a vykon\u00e1va sa iba v pr\u00edpade kme\u0148ov sp\u00f4sobuj\u00facich invaz\u00edvnu infekciu alebo z\u00e1pal stredn\u00e9ho ucha, preh\u013ead s\u00e9rotypov nie je s\u00fa\u010das\u0165ou na\u0161ej pr\u00e1ce. Na\u0161e \u00a0v\u00fdsledky m\u00f4\u017eeme porovna\u0165 \u00a0s v\u00fdsledkami podobnej \u0161t\u00fadie ktor\u00fa vykon\u00e1vali v Litve medzi febru\u00e1rom 2012 \u00a0a marcom 2013(12). Do \u0161t\u00fadie zahrnuli \u00a0celkovo \u00a0900 \u00a0det\u00ed vo veku \u00a0do \u00a06 rokov \u00a0s pr\u00edznakmi\u00a0ak\u00fatnej \u00a0infekcie horn\u00fdch alebo \u00a0doln\u00fdch d\u00fdchac\u00edch ciest \u00a0a ktor\u00e9 neboli \u00a0o\u010dkovan\u00e9 proti pneumokokom. <em>S. pneumoniae <\/em>bol izolovan\u00fd z v\u00fdterov horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0u 367 det\u00ed, miera ich koloniz\u00e1cie pneumokokom bola 40,8 %. Ferreira a kol. v roku 2001(13) \u00a0sledovali v\u00fdskyt <em>S. pneumoniae <\/em>v s\u00fabore 400 det\u00ed do 5 rokov s pr\u00edznakmi \u00a0rinofaryngit\u00eddy. Vzorky odoberali v obdob\u00ed od j\u00fana 1997 do m\u00e1ja 1998 na detskej pohotovosti dvoch nemocn\u00edc v Sao Paule v Braz\u00edlii. Pneumokoka izolovali z nazofaryngu 139 det\u00ed, miera koloniz\u00e1cie bola 34,8 %. V na\u0161om s\u00fa- bore sa vyskytoval n\u00e1lez <em>S. pneumoniae <\/em>v 10,86 % vzoriek det\u00ed do 5 rokov veku. Syrjanen a kol.(1) sledovali v\u00fdskyt nosi\u010dsk\u00fdch kme\u0148ov <em>S. pneumoniae <\/em>u 329 det\u00ed vo veku 2 mesiacov a\u017e 2 roky, ke\u010f boli deti zdrav\u00e9 a n\u00e1sledne aj pri prejavoch infekcie horn\u00fdch d\u00fdchac\u00edch ciest, resp. pri pr\u00edznakoch ak\u00fatneho z\u00e1palu stredou\u0161ia. Z 3 024 v\u00fdterov z nazofaryngu odobrat\u00fdch od det\u00ed v bezpr\u00edznakovom \u0161t\u00e1diu zaznamenali pr\u00edtomnos\u0165 <em>S. pneumo<\/em><em>nia<\/em><em>e <\/em>v 649 vzork\u00e1ch (21 %). U zdrav\u00fdch \u00a0det\u00ed pozorovali zvy\u0161ovanie v\u00fdskytu nosi\u010dstva <em>S. pneumoniae <\/em>vekom \u00a0(9 % u 2-mesa\u010dn\u00fdch a\u017e 43 % u 2-ro\u010dn\u00fdch). Z 2007 \u00a0v\u00fdterov z nazofarnygu odobrat\u00fdch od det\u00ed sledovan\u00e9ho s\u00faboru v \u010dase prejavov infekcie d\u00fdchac\u00edch ciest \u00a0alebo \u00a0ak\u00fatneho z\u00e1palu stredou\u0161ia zaznamenali n\u00e1lez \u00a0<em>S. pneumoniae <\/em>v 826 (41 %) vzork\u00e1ch. V na\u0161om s\u00fabore sme tie\u017e pozorovali postupn\u00fd n\u00e1rast v\u00fdskytu <em>S. pneu<\/em><em>&#8211; <\/em><em>monia<\/em><em>e <\/em>s vekom, s v\u00fdnimkou pre\u0161ovsk\u00e9ho regi\u00f3nu. Percent\u00e1 v\u00fdskytu v na\u0161om s\u00fabore s\u00fa v\u0161ak ni\u017e\u0161ie, mo\u017en\u00fdm vysvetlen\u00edm je ve\u013ekos\u0165 s\u00faboru \u2013 v spom\u00ednanej publik\u00e1cii \u00a0bolo analyzovan\u00fdch 3 024 v\u00fdterov z horn\u00fdch d\u00fdchac\u00edch ciest zdrav\u00fdch a 2 007 v\u00fdterov chor\u00fdch \u00a0det\u00ed, v na\u0161om s\u00fabore sme vyhodnotili v\u00fdsledky 115 804 v\u00fdterov z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest det\u00ed do 5 rokov veku \u00a0s prejavmi \u00a0ak\u00fatnej \u00a0infekcie \u00a0horn\u00fdch d\u00fdchac\u00edch ciest. Cel\u00fd rad dostupn\u00fdch \u0161t\u00fadi\u00ed bolo zameran\u00fdch preva\u017ene na zmapovanie v\u00fdskytu <em>S. pneumoniae <\/em>v popul\u00e1cii \u00a0bez pr\u00edznakov\u00fdch det\u00ed v s\u00favislosti s pl\u00e1novan\u00fdm zaveden\u00edm o\u010dkovania proti tejto bakt\u00e9rii. Ke\u010f\u017ee tieto publik\u00e1cie sa t\u00fdkaj\u00fa v\u00fdskytu <em>S. pne<\/em><em>umonia<\/em><em>e <\/em>v s\u00faboroch zdrav\u00fdch det\u00ed, \u00a0nie je \u00faplne relevantn\u00e9 porovn\u00e1va\u0165 ich v\u00fdsledky s na\u0161imi \u00a0v\u00fdsledkami. Kumar a kol.(14) na s\u00fabore 190 bezpr\u00edznakov\u00fdch det\u00ed vo veku 3 mesiacov a\u017e 5 rokov sledovali nazofaryng\u00e1lne nosi\u010dstvo <em>S. pneumoniae <\/em>v obdob\u00ed \u00a0od decembra 2010 \u00a0do decembra 2011 \u00a0v Bangalore (India). Pneumokoka izolovali u 53 zo 190 det\u00ed, \u010do predstavuje 27,9 %. Vo vekovej distrib\u00facii v\u00fdskytu pneumokokov sme zaznamenali zna\u010dn\u00fa odli\u0161nos\u0165 medzi v\u00fdsledkami publik\u00e1cie Kumar \u00a0a kol. a na\u0161imi \u00a0v\u00fdsledkami. U n\u00e1s \u00a0bola prevaha v\u00fdskytu\u00a0<em>S<\/em><em>. pneumoniae <\/em>u det\u00ed vo vekovej kateg\u00f3rii 3- a\u017e 5-ro\u010dn\u00fdch, len v pre\u0161ovskom regi\u00f3ne bol v\u00fdskyt tejto bakt\u00e9rie najvy\u0161\u0161\u00ed u det\u00ed mlad\u0161\u00edch ako 3 roky. V publik\u00e1cii Kumar a kol. uv\u00e1dzaj\u00fa najvy\u0161\u0161\u00ed v\u00fdskyt <em>S. pneumoniae <\/em>u det\u00ed vo veku 3 a\u017e 12 mesiacov (49,2 %). Podobn\u00e1 multicentrick\u00e1 \u0161t\u00fadia bola vykonan\u00e1 v Rumunsku v obdob\u00ed od novembra 2011 do apr\u00edla 2013 v \u0161tyroch mest\u00e1ch na s\u00fabore 2 000 zdrav\u00fdch \u00a0det\u00ed do 5 rokov veku(15). <em>S<\/em><em>. pneumoniae <\/em>izolovali z v\u00fdterov z nazofaryngu 505 det\u00ed, nosi\u010dstvo pneumokoka v sledovanom s\u00fabore bola 25,25 %. Pozorovali \u00a0n\u00e1rast v\u00fdskytu \u00a0nosi\u010dstva <em>S. pneumoniae <\/em>vekom \u00a0\u2013\u00a016,7 % u det\u00ed do 11 mesiacov a 29,4 % u det\u00ed 3- a\u017e 5-ro\u010dn\u00fdch. Zauj\u00edmav\u00e9 s\u00fa vz\u00e1jomn\u00e9 vz\u0165ahy potenci\u00e1lne patog\u00e9nnych bakt\u00e9ri\u00ed a ich s\u00fa\u010dasn\u00fd v\u00fdskyt na sliznici horn\u00fdch \u00a0d\u00fdchac\u00edch ciest(4,5,6,7,8). V na\u0161om s\u00fabore sa tie\u017e potvrdila \u010dastej\u0161ia koincidencia <em>S. pneumoniae <\/em>a <em>M. catarrhalis <\/em>ako <em>S. pneumoniae <\/em>a ostatn\u00fdch potenci\u00e1lne patog\u00e9nnych mikroorganizmov. S\u00fa\u010dasn\u00fd n\u00e1lez <em>S. pneumoniae <\/em>s <em>M. catarrhalis <\/em>sa vyskytoval v 24,47 %, k\u00fdm s\u00fa\u010dasn\u00fd n\u00e1lez \u00a0<em>S. pneumoniae <\/em>a <em>H. influenzae <\/em>sme pozorovali v 8,02 %. <em>S. pneumoniae <\/em>a <em>S. aureus <\/em>sa vyskytovali spolu v 5,01 % analyzovan\u00fdch vzoriek. Uveden\u00e9 skuto\u010dnosti jednozna\u010dne sved\u010dia o d\u00f4le\u017eitosti \u00a0bakteriologickej \u00a0kultiva\u010dnej anal\u00fdzy vzoriek z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0aj v pr\u00edpadoch, \u017ee pacient m\u00e1 spo\u010diatku pr\u00edznaky sved\u010diace o v\u00edrusovej etiol\u00f3gii. V pr\u00edpade stredne mas\u00edvneho a mas\u00edvneho n\u00e1lezu \u00a0podmienene patog\u00e9nnych bakt\u00e9ri\u00ed \u00a0je d\u00f4le\u017eit\u00e9 stanovi\u0165 \u00a0citlivos\u0165 na antimikrobi\u00e1lne l\u00e1tky, aby v pr\u00edpade potreby \u00a0bola \u00a0mo\u017en\u00e1 cielen\u00e1 antibiotick\u00e1 \u00a0lie\u010dba. V na\u0161om s\u00fabore sme do v\u00fdsledkov\u00e9ho listu uviedli rezistenciu\/necitlivos\u0165 na penicil\u00edn, t. j. nepou\u017eite\u013e- nos\u0165 peror\u00e1lneho fenoxymetylpenicil\u00ednu u ambulantn\u00fdch pacientov v pr\u00edpade 14 a\u017e 41 % testovan\u00fdch kme\u0148ov \u00a0<em>S. pneu<\/em><em>&#8211; <\/em><em>moniae<\/em>. V rezistencii na penicil\u00edn \u00a0sme zaznamenali v\u00fdrazn\u00fd geografick\u00fd rozdiel \u2013 vo v\u00e4\u010d\u0161ine regi\u00f3nov\u00a0 Z\u00e1padn\u00e9ho Slovenska bola t\u00e1to rezistencia okolo 20 %, s v\u00fdnimkou regi\u00f3nu labo- rat\u00f3ria \u00a0v Topo\u013e\u010danoch, kde bol podiel \u00a0kme\u0148ov necitliv\u00fdch \u00a0na penicil\u00edn 36 %. Na V\u00fdchodnom Slovensku bola \u00a0miera necitlivosti kme\u0148ov <em>S. pneumoniae <\/em>na penicil\u00edn v pre\u0161ovskom regi\u00f3ne 41 %. Podiel kme\u0148ov necitliv\u00fdch na penicil\u00edn v regi\u00f3noch Z\u00e1padn\u00e9ho \u00a0Slovenska (okrem\u00a0 \u00a0Topo\u013e\u010dian) \u00a0je \u00a0porovnate\u013en\u00fd s v\u00fdsledkami podobn\u00fdch pr\u00e1c, v ktor\u00fdch \u00a0bol hodnoten\u00fd antibiogram neinvaz\u00edvnych kme\u0148ov \u00a0<em>S. pneumonia<\/em>e pod\u013ea aktu\u00e1lnych z\u00e1sad EUCAST. Rusk\u00ed autori Mayanskiy a kol. v roku 2013 publikovali v\u00fdsledky rezistencie 863 neinvaz\u00edvnych izol\u00e1tov <em>S. <\/em><em>p<\/em><em>neumonia<\/em><em>e <\/em>izolovan\u00fdch z d\u00fdchac\u00edch ciest a zo stredou\u0161ia. Zaznamenali 28 % kme\u0148ov necitliv\u00fdch \u00a0na penicil\u00edn(16). \u00a0Autori z Litvy analyzovali v\u00fdtery z nazofaryngu 900 det\u00ed v pred\u0161kolskom \u00a0veku s ak\u00fatnou infekciou horn\u00fdch d\u00fdchac\u00edch ciest. Zaznamenali 15,8 % kme\u0148ov necitliv\u00fdch na penicil\u00edn(12). Rezistencia na makrolidov\u00e9 antibiotik\u00e1 sa v na\u0161om s\u00fabore pohybovala od 23 do 44 % a na linkozamidy od 14 do 33 %. Rezistencia na kotrimoxazol sa v na\u0161om s\u00fabore vyskytovala od 11 do 32 %. Ke\u010f to porovn\u00e1me s v\u00fdsledkami podobnej pr\u00e1ce(12), kde autori zaznamenali rezistenciu testovan\u00fdch kme\u0148ov \u00a0<em>S. pneumo<\/em><em>nia<\/em><em>e <\/em>u \u00a0det\u00ed \u00a0v pred\u0161kolskom veku \u00a0na \u00a0erytromyc\u00edn 21,3 \u00a0%, na klindamyc\u00edn \u00a016,9 % a kotrimoxazol 27,3 %, m\u00f4\u017eeme poveda\u0165, \u017ee u n\u00e1s \u00a0je miera rezistencie kme\u0148ov \u00a0<em>S. pneumoniae <\/em>izolovan\u00fdch z horn\u00fdch\u00a0 d\u00fdchac\u00edch ciest \u00a0det\u00ed s infekciami horn\u00fdch d\u00fdchac\u00edch ciest \u00a0vy\u0161\u0161ia. Na\u0161e \u00a0v\u00fdsledky s\u00fa v s\u00falade s v\u00fdsledkami projektu \u00a0MIKROMED, pod\u013ea \u00a0ktor\u00fdch \u00a0u\u017e v prvom polroku\u00a02014 bola rezistencia <em>S. pneumoniae <\/em>na makrolidov\u00e9 antibiotik\u00e1 viac ako 30 %(17). Nie je dobr\u00e1 spr\u00e1va ani to, \u017ee zo 100 kme- \u0148ov rezistentn\u00fdch na fenoxymetylpenicil\u00edn so z\u00f3nou \u00a0oxacil\u00ednu\u00a0&lt; 8 mm, makrolidy, linkozamidy \u00a0a kotrimoxazol bolo v kvantitat\u00edvnom teste citlivosti citliv\u00fdch na ampicil\u00edn (amoxicil\u00edn) \u00a0iba 9 %, intermedi\u00e1rne citliv\u00fdch 34% a rezistentn\u00fdch 57%. S\u00edce sme analyzovali iba 100 kme\u0148ov <em>S. pneumoniae <\/em>rezistentn\u00fdch na antibiotik\u00e1 ktor\u00e9 by prich\u00e1dzali do \u00favahy v peror\u00e1lnej lie\u010dbe det\u00ed \u00a0s ak\u00fatnou infekciou \u00a0horn\u00fdch \u00a0d\u00fdchac\u00edch ciest, \u00a0ale \u00a0tieto predbe\u017en\u00e9 v\u00fdsledky poukazuj\u00fa na to, \u017ee pri interpret\u00e1cii MIC ampicil\u00ednu (amoxicil\u00ednu) pod\u013ea krit\u00e9ri\u00ed EUCAST by ani toto antibiotikum nebolo vhodn\u00e9 v lie\u010dbe. Zistili sme v\u0161ak, \u017ee pri interpret\u00e1cii t\u00fdchto \u00a0v\u00fdsledkov pod\u013ea krit\u00e9ri\u00ed americkej normy \u00a0CL- SI(18,19), \u00a0v\u00fdsledky \u00a0kvantitat\u00edvneho testovania \u00a0citlivosti \u00a0nami vybran\u00fdch\u00a0 100 kme\u0148ov \u00a0<em>S. pneumoniae na <\/em>ampicil\u00edn (amoxicil\u00edn) by boli ove\u013ea priaznivej\u0161ie. Na z\u00e1klade interpreta\u010dn\u00fdch krit\u00e9ri\u00ed CLSI v nami otestovanom s\u00fabore 100 kme\u0148ov <em>S. pneumo<\/em><em>nia<\/em><em>e <\/em>by bolo 43% kme\u0148ov \u00a0citliv\u00fdch na amoxicil\u00edn (MIC \u2264 2 ug\/ ml), 55% kme\u0148ov \u00a0intermedi\u00e1rne citliv\u00fdch (MIC &gt; 2 ug\/ml &lt; 8 ug\/ml) a iba 2 % kme\u0148ov by sme hodnotili \u00a0ako \u00a0rezistentn\u00e9 (MIC \u2265 8 ug\/ml). T\u00e1to ot\u00e1zka v\u0161ak vy\u017eaduje \u010fal\u0161iu anal\u00fdzu \u00a0na v\u00e4\u010d\u0161om s\u00fabore kme\u0148ov \u00a0po rut\u00ednnom zaveden\u00ed kvantitat\u00edvne- ho testovania citlivosti <em>S. pneumoniae <\/em>na ampicil\u00edn (amoxicil\u00edn) v pr\u00edpade kme\u0148ov rezistentn\u00fdch na v\u0161etky ostatn\u00e9 antibiotik\u00e1, ktor\u00e9 \u00a0je mo\u017en\u00e9 pod\u00e1va\u0165 \u00a0v detskom veku \u00a0v peror\u00e1lnej forme.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z\u00e1ver<\/strong><\/p>\n<p>Na\u0161a \u0161t\u00fadia pouk\u00e1zala na\u00a0 potrebu prehodnoti\u0165 a bli\u017e\u0161ie analyzova\u0165 interpreta\u010dn\u00e9 krit\u00e9ri\u00e1\u00a0 kvantitat\u00edvneho testu citlivosti na ampicil\u00edn (amoxicil\u00edn) v pr\u00edpade kme\u0148ov izolovan\u00fdch z v\u00fdterov z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest det\u00ed ktor\u00fdm <em>S. pneumo<\/em><em>niae <\/em>sp\u00f4sobuje opakovan\u00e9 komplik\u00e1cie zdravotn\u00e9ho stavu s pr\u00edznakmi \u00a0ak\u00fatneho z\u00e1palu horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0a na z\u00e1klade testu citlivosti \u00a0nie je in\u00e1 vhodn\u00e1 alternat\u00edva lie\u010dby. Ke\u010f\u017ee u t\u00fdchto det\u00ed sa v\u00e4\u010d\u0161inou jedn\u00e1 o nosi\u010dsk\u00fd stav, treba v\u017edy individu\u00e1lne prehodnoti\u0165 potrebu peror\u00e1lnej antimikrobi\u00e1lnej lie\u010dby, v menej \u00a0z\u00e1va\u017en\u00fdch pr\u00edpadoch sta\u010d\u00ed aplik\u00e1cia antibiot\u00edk \u00a0lok\u00e1lne \u00a0na sliznicu \u00a0nosa, napr. neomyc\u00edn s bacitrac\u00ednom alebo \u00a0ofloxac\u00edn. V pr\u00edpade pretrv\u00e1vania nosi\u010dstva <em>S. pneumoniae <\/em>m\u00f4\u017ee by\u0165 rie\u0161en\u00edm aj imunomodula\u010dn\u00e1 lie\u010dba komer\u010dn\u00e1 alebo \u00a0individualizovan\u00e1, ktor\u00e1 \u00a0napom\u00e1ha mobiliz\u00e1cii faktorov vrodenej imunity a zvl\u00e1dnutiu recidivuj\u00facich z\u00e1palov horn\u00fdch d\u00fdchac\u00edch ciest komplikovan\u00fdch podmienene patog\u00e9nnymi bakt\u00e9riami.<\/p>\n<p>&nbsp;<\/p>\n<p><strong><em>P<\/em><\/strong><strong><em>o\u010fako<\/em><\/strong><strong><em>v<\/em><\/strong><strong><em>anie<\/em><\/strong><\/p>\n<p><em>Autori \u00a0publik\u00e1cie \u00a0\u010fakuj\u00fa \u00a0za \u00a0spolupr\u00e1cu v\u0161etk\u00fdm \u00a0kolegom z pracov\u00edsk HPL uveden\u00fdch v publik\u00e1cii.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Literat\u00fara<\/strong><br \/>\n1. Syrjanen RK, et al. Nasopharyngeal carriage of Streptococcus pneumoniae<br \/>\nin Finnish children younger than 2 years old. The Journal of Infectious<br \/>\nDiseases 2001; 184: 451-459.<br \/>\n2. Bogaert D, de Groot R, Hermans PWM Streptococcus pneumoniae<br \/>\ncolonisation: the key to pneumococcal disease. The Lancet Infectious<br \/>\nDiseases 2004; 4: 144-154. P\u00f4vodn\u00e9 pr\u00e1ce 1\/2017 15<br \/>\n3. McCullers JA, Insights into the interaction between influenza virus<br \/>\nand pneumococcus. Clinical Microbiology Reviews 2006; 19: 571-582.<br \/>\n4. Astrid A, et al. Viral and Bacterial Interactions in the Upper Respiratory<br \/>\nTract. Plos Pathogens 2013; 9(1): e1003057.<br \/>\n5. Regev-Yochay G, et al. Is nasopharyngeal carriage of Streotococcus<br \/>\npneumoniae protective against carriage of Staphylococcus aureus? 43rd<br \/>\nICCAC; Chicago; sept 14-17, 2003, abstr. G-2048.<br \/>\n6. Pericone CD, et al. Inhibitory and bactericidal effects of hydrogen peroxide<br \/>\nproduction by Streptococcus pneumoniae on other inhabitants of<br \/>\nthe upper respiratory tract. Infection and Imunity 2000; 68(7): 3990-3997.<br \/>\n7. Shakhnovich EA, King SJ, Weiser JN Neuraminidase expressed by<br \/>\nstreptococcus pneumoniae desialylates the lipopolysaccharide of Neisseria<br \/>\nmeningitidis and Haemophilus influenzae: A paradigm for interbacterial<br \/>\ncompetition among pathogens of the human respiratory tract. Infection<br \/>\nand Imunity 2002; 70(12): 7161-7164.<br \/>\n8. Perez AC, Pang B, King LB, et al. Residence of Streptococcus pneumoniae<br \/>\nand Moraxella catarrhalis within polymicrobial biofilm promotes antibiotic<br \/>\nresistance and bacterial persistence in vivo. Pathogens and disease<br \/>\n2014; 70(3): 280-288.<br \/>\n9. Tomasz A. Antibiotic resistence in Streptococcus pneumoniae. Clinical<br \/>\nInfectious Diseases 1997; 24(Suppl 1): S85-8.<br \/>\n10. European Committee on Antimicrobial Susceptibility Testing Breakpoint<br \/>\ntables for interpretation of MICs and zone diameters Version 4.0,<br \/>\nvalid from 2014-01-01, Dostupn\u00e9 na http:\/\/www.eucast.org\/<br \/>\n11. European Committee on Antimicrobial Susceptibility Testing Breakpoint<br \/>\ntables for interpretation of MICs and zone diameters Version 5.0,<br \/>\nvalid from 2015-01-01, Dostupn\u00e9 na http:\/\/www.eucast.org\/<br \/>\n12. Stacevi\u010diene I, et al. Antibiotic resistance of Streptococcus pneumoniae,<br \/>\nisolated from nasopharynx of preschol children with acute respiratory<br \/>\ntract infection in Lithuana. BMC Infectious Diseases 2016; 16: 216.<br \/>\n13. Ferreira LM, et al. Nasopharyngeal colonisation and antimicrobial resistance<br \/>\nof Streptococcus pneumoniae isolated from children with acute<br \/>\nrhinopharyngitis. Journal de Pediatria 2001; 77(3): 227-234.<br \/>\n14. Kumar KLR, et al. Nasopharyngeal carriage, antibiogram &amp; serotype<br \/>\ndistribution of Streptococcus pneumoniae among healthy under five children.<br \/>\nIndian J Med Res 2014; 140: 216-220.<br \/>\n15. Luminos M, et al. Nasopharyngeal carriage of Streptococcus pneumoniae<br \/>\nin Romanian children before the introduction of the pneumococcal<br \/>\nconjugated vaccination into the national immunization programe:<br \/>\na national, multi-centre, cross-sectional observational study. International<br \/>\nJournal of Infectious Diseases 2014; 29: 169-173.<br \/>\n16. Mayanskiy N, et al. Serotypes and antibiotic resistance of non-invasive<br \/>\nStreptococcus pneumoniae circulating in pediatric hospitals in Moscow,<br \/>\nRussia. International Journal of Infectious Diseases 2014; 20: 58-62.<br \/>\n17. L\u00ed\u0161kov\u00e1 A. Racion\u00e1lna antibiotick\u00e1 terapia respira\u010dn\u00fdch infekci\u00ed.<br \/>\nPrim\u00e1rny kontakt 2014; 2(6): 14-16.<br \/>\n18. Performance standards for antimicrobial susceptibility testing , twenty<br \/>\nfourth informational supplement, CLSI 2014; M100-S24<br \/>\n19. Performance standards for antimicrobial susceptibility testing , twenty<br \/>\nfourth informational supplement, CLSI 2015; M100-S25<br \/>\n20. Liofilchem\u00ae \u2013 MIC Test Strip Technical Sheet Streptococcus pneumoniae<br \/>\n&#8211; MTS23 Rev.6<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*V\u0161etky tabu\u013eky, grafy a obr\u00e1zky, ktor\u00e9 s\u00fa s\u00fa\u010das\u0165ou \u010dl\u00e1nku, n\u00e1jdete v prilo\u017eenom PDF s\u00fabore na konci \u0161t\u00fadie. \u00davod S. pneumoniae je bakt\u00e9ria ktor\u00e1 \u00a0\u010dasto os\u00edd\u013euje \u00a0sliznice horn\u00fdch \u00a0d\u00fdchac\u00edch ciest. Z asymptomatickej koloniz\u00e1cie sa v\u0161ak m\u00f4\u017ee \u00a0vyvin\u00fa\u0165 ochorenie d\u00fdchac\u00edch ciest \u00a0ale aj invaz\u00edvna infekcia. Nazofaryng\u00e1lne nosi\u010dstvo pneumokokov je \u010dastej\u0161ie \u00a0u mal\u00fdch \u00a0det\u00ed, ktor\u00e9 \u00a0s\u00fa rezervo\u00e1rom a<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292],"tags":[618,619,617,332],"class_list":["post-1015","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-children-aged-under-5","tag-eucast","tag-resistance-to-antibiotics","tag-streptococcus-pneumoniae-en","typ_clanku-original-work"],"acf":{"abstrakt":"<p>The objective of our paper was to monitor prevalence of Streptococcus pneumoniae phyla in smears from throat and nose of children under the age of 5 suffering from acute inflammations of upper airways in the geographical regions covered by seven laboratories of HPL spol.\u00a0 s r. o., to determine the status quo in terms of susceptibility to antibiotics in compliance with the current EUCAST guidelines and to express the share of simultaneous presence of this bacteria with other pathogens or potential pathogens of upper airways. Prevalence of S. pneumoniae in the monitored age category of children under 5 increases with age and the highest level of prevalence is in the category of children aged 3 to 5.\u00a0 The region of Pre\u0161ov constitutes an exception, where we registered an increased prevalence of this bacteria in children aged under 3. In our sample, we registered resistance\/non-susceptibility to phenoxymethylpenicillin, i.e. inapplicability in outpatient treatment in the case of 14 to 41% of the tested phyla of S. pneumoniae. Resistance to macrolide antibiotics in our universe oscillated between 23 and 44 % and in the case of lincosamides between 14 and 33 %. Resistance to cotrimoxazole oscillated between 11 and 32 %. From the selected 100 phyla of S. pneumoniae resistant to phenoxymethylpenicillin, macrolides, lincosamides and cotrimoxazole, we assessed 57% of the phyla as resistant to ampicillin (amoxicillin) in the quantitative susceptibility test compliant with the current EUCAST guidelines. We compared the interpretation of results of the quantitative ampicillin (amoxicillin) susceptibility test of the selected pool of 100 S. pneumoniae phyla assessed in compliance with the current EUCAST standards and CLSI standards and discovered a significant difference in the resulting interpretation of findings.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Key words<\/strong>: Streptococcus pneumoniae, resistance to antibiotics, children aged under 5, EUCAST<\/p>\n","casopis":[{"ID":735,"post_author":"7","post_date":"2017-04-06 13:21:01","post_date_gmt":"2017-04-06 11:21:01","post_content":"<ul>\r\n \t<li>Pseudoglandular nevus \u2013 a rare morphology of melanocytic nevus (case report)<\/li>\r\n \t<li>Differential molecular diagnosis of multiple myeloma and Waldenstr\u00f6m macroglobulinemia<\/li>\r\n \t<li>Molecular analysis of prognostically significant markers of chronic lymphocytic leukemia<\/li>\r\n \t<li>Prevalence of <em>Streptococcus pneumoniae<\/em> phyla in inflammatory diseases of upper airways in preschool age children and their resistance to antibiotics<\/li>\r\n \t<li>Malign melanoma - new aspects of research<\/li>\r\n \t<li style=\"list-style-type: none;\"><\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-1","to_ping":"","pinged":"","post_modified":"2017-08-16 21:11:52","post_modified_gmt":"2017-08-16 19:11:52","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/?post_type=casopis&#038;p=735\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"10","upload_clanok":{"ID":1016,"id":1016,"title":"Performance of a DNA methylation marker panel using liquid-based cervical scrapes to detect cervical cancer and its precancerous stages","filename":"Performance-of-a-DNA-methylation-marker-panel-using-liquid-based-cervical-scrapes-to-detect-cervical-cancer-and-its-precancerous-stages-1.pdf","filesize":849287,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/04\/Performance-of-a-DNA-methylation-marker-panel-using-liquid-based-cervical-scrapes-to-detect-cervical-cancer-and-its-precancerous-stages-1.pdf","link":"https:\/\/www.newslab.sk\/en\/prevalence-of-streptococcus-pneumoniae-phyla-in-inflammatory-diseases-of-upper-airways-in-preschool-age-children-and-their-resistance-to-antibiotics\/performance-of-a-dna-methylation-marker-panel-using-liquid-based-cervical-scrapes-to-detect-cervical-cancer-and-its-precancerous-stages-2\/","alt":"","author":"7","description":"","caption":"","name":"performance-of-a-dna-methylation-marker-panel-using-liquid-based-cervical-scrapes-to-detect-cervical-cancer-and-its-precancerous-stages-2","status":"inherit","uploaded_to":1015,"date":"2017-04-06 19:09:49","modified":"2017-04-06 19:09:49","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1015","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1015"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1015\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1015"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1015"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1015"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}