{"id":1023,"date":"2017-04-06T22:51:26","date_gmt":"2017-04-06T20:51:26","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/04\/06\/vyskyt-betahemolytickych-streptokokov-izolovanych-z-hornych-dychacich-ciest-pacientov-z-okresov-komarno-a-nove-zamky-a-ich-rezistencia-na-antibiotika\/"},"modified":"2017-10-03T09:05:56","modified_gmt":"2017-10-03T07:05:56","slug":"prevalence-of-beta-hemolytic-streptococci-isolated-from-upper-airways-of-patients-in-the-districts-of-komarno-and-nove-zamky-and-their-resistance-to-antibiotics","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/prevalence-of-beta-hemolytic-streptococci-isolated-from-upper-airways-of-patients-in-the-districts-of-komarno-and-nove-zamky-and-their-resistance-to-antibiotics\/","title":{"rendered":"Prevalence of beta-hemolytic streptococci isolated from upper airways of patients in the districts of Kom\u00e1rno and Nov\u00e9 Z\u00e1mky and their resistance to antibiotics"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf <\/span><\/strong>\r\n <strong><span style=\"color: #ff0000;\">attachment at the end of the paper.<\/span> <\/strong><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>\u00davod<\/strong><br \/>\nS. pneumoniae je bakt\u00e9ria ktor\u00e1 \u010dasto os\u00edd\u013euje sliznice horn\u00fdch d\u00fdchac\u00edch ciest. Z asymptomatickej koloniz\u00e1cie sa v\u0161ak m\u00f4\u017ee vyvin\u00fa\u0165 ochorenie d\u00fdchac\u00edch ciest ale aj invaz\u00edvna infekcia. Nazofaryng\u00e1lne nosi\u010dstvo pneumokokov je \u010dastej\u0161ie u mal\u00fdch det\u00ed, ktor\u00e9 s\u00fa rezervo\u00e1rom a vektorom tejto<br \/>\nbakt\u00e9rie pri jej horizont\u00e1lnom \u0161\u00edren\u00ed v komunite. Koloniz\u00e1cia sliznice nazofaryngu potenci\u00e1lne patog\u00e9nnymi bakt\u00e9riami je\u00a0dynamick\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<br \/>\nvyspel\u00fdch \u0161t\u00e1toch rastie s vekom. Vo F\u00ednsku Syrjanen a kol.(1) zaznamenali v\u00fdskyt S. pneumoniae u 13 % det\u00ed do 6 mesiacov a u 43 % det\u00ed vo veku nad 19 mesiacov. Zo socioekonomick\u00fdch a environment\u00e1lnych faktorov na 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<br \/>\nmikroorganizmami na sliznici horn\u00fdch 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 b\u00fdva \u0165a\u017ekou komplik\u00e1ciou pneumokokov\u00e1 pneum\u00f3nia(3). Nielen pri chr\u00edpke, ale v\u0161eobecne pri infekci\u00e1ch sp\u00f4soben\u00fdch respira\u010dn\u00fdmi v\u00edrusmi, ako napr. rinov\u00edrus, metapneumov\u00edrus, RSV, adenov\u00edrus, koronav\u00edrusy je vy\u0161\u0161ia predispoz\u00edcia k bakteri\u00e1lnej superinfekcii v d\u00f4sledku naru\u0161enia epitelovej bari\u00e9ry v\u00edrusom, pre zv\u00fd\u0161enie expresie adhez\u00edvnych prote\u00ednov via\u017eucich potenci\u00e1lne patog\u00e9nne bakt\u00e9rie, a pre naru\u0161enie funkcie neutrofilov, NK buniek a monocytov(3). Interakcie medzi naj\u010dastej\u0161\u00edmi podmienen\u00fdmi patog\u00e9nmi kolonizuj\u00facimi horn\u00e9 d\u00fdchacie cesty<br \/>\nS. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis a Staphylococcus aureus boli dok\u00e1zan\u00e9 aj v experiment\u00e1lnych podmienkach(4). S. pneumoniae je mohutn\u00fdm producentom peroxidu vod\u00edka. Ten p\u00f4sob\u00ed bakteric\u00eddne aj na bakt\u00e9rie produkuj\u00face katal\u00e1zu (S. aureus, H. influenzae), enz\u00fdm, ktor\u00fd<br \/>\nrozklad\u00e1 peroxid vod\u00edka(5,6). In\u00fdm mechanizmom vz\u00e1jomnej interferencie medzi S. pneumoniae a H. influenzae je p\u00f4sobenie pneumokokovej neuraminid\u00e1zy na povrchov\u00e9 sialov\u00e9 kyseliny H. influenzae, \u010d\u00edm sa zabr\u00e1ni adherencii hemofila k sliznici(7). Pravdepodobne najpriaznivej\u0161ie vz\u0165ahy s\u00fa medzi S. pneumoniae a M. catarrhalis. Perez a kol. v roku 2014(8) v \u0161t\u00fadii vz\u0165ahov S. pneumoniae a M. catarrhalis v biofilmoch zistili, \u017ee v pr\u00edtomnosti S. pneumoniae doch\u00e1dza k mno\u017eeniu kult\u00fary M. catarrhalis. Tento fenom\u00e9n je sprostredkovan\u00fd sign\u00e1lnou molekulou Al-2. M. catarrhalis 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 mikroorganizmov. S. pneumoniae je bakt\u00e9ria, ktor\u00e1 v posledn\u00fdch \u0161tyridsiatich rokoch sa zaradila medzi terapeuticky problematick\u00e9 mikroorganizmy pre \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<br \/>\npeptidoglyk\u00e1n. S. pneumoniae 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. E. coli, Klebsiella spp., Neisseria spp., Haemophilus spp.)(9). Cie\u013eom tejto publik\u00e1cie je monitorova\u0165 v\u00fdskyt kme\u0148ov S. pneumoniae 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 vo vybran\u00fdch regi\u00f3noch Slovenska, zisti\u0165 jeho koincidenciu s in\u00fdmi patog\u00e9nmi alebo potenci\u00e1lnymi patog\u00e9nmi horn\u00fdch d\u00fdchac\u00edch ciest a prezentova\u0165 aktu\u00e1lny stav ich citlivosti na 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>S\u00fabor vzoriek tvorili kmene betahemolytick\u00fdch streptokokov izolovan\u00fdch z v\u00fdterov \u00a0hrdla \u00a0a nosa pri ak\u00fatnych infekci\u00e1ch horn\u00fdch \u00a0d\u00fdchac\u00edch ciest (diagn\u00f3zy J00-J06) od \u00a0pacientov \u00a0v obdob\u00ed \u00a0od 1. 1. 2014 \u00a0do 31. 12. 2015 \u00a0z okresov Kom\u00e1rno a Nov\u00e9 Z\u00e1mky. Vzorky biologick\u00fdch materi\u00e1lov odobrali o\u0161etruj\u00faci lek\u00e1ri na detoxikovan\u00fd tamp\u00f3n, ktor\u00fd po umiestnen\u00ed do transportn\u00e9ho m\u00e9dia pod\u013ea \u00a0Amiesa s akt\u00edvnym uhl\u00edm bol v de\u0148 \u00a0odberu transportovan\u00fd do laborat\u00f3ria HPL spol. s r. o., v Kom\u00e1rne. V\u00fdtery z horn\u00fdch d\u00fdchac\u00edch ciest boli o\u010dkovan\u00e9 na\u00a0 krvn\u00fd agar \u00a0Columbia \u00a0so \u00a07 % baranej krvi v s\u00falade so \u0161tandardn\u00fdmi postupmi HPL spol. s r. o. Nao\u010dkovan\u00e9 \u00a0kultiva\u010dn\u00e9 m\u00e9di\u00e1 \u00a0boli inkubovan\u00e9 18 a\u017e 20 hod\u00edn pri teplote 35 \u00b0C v pr\u00edtomnosti 5 % CO2. Po uplynut\u00ed lehoty inkub\u00e1cie \u00a0ich hodnotili \u00a0laborat\u00f3rni diagnostici a n\u00e1lezy \u00a0boli zaznamenan\u00e9 v laborat\u00f3rnom informa\u010dnom syst\u00e9me laborat\u00f3ria. Suspektn\u00e9 kol\u00f3nie betahemolytick\u00fdch streptokokov boli izolovan\u00e9 na kultiva\u010dnej \u00a0p\u00f4de \u00a0krvn\u00fd agar \u010d. 2 so 7 % baranej krvi. Pri identifik\u00e1cii izolovan\u00fdch betahemolytick\u00fdch streptokokov sme sa riadili morfol\u00f3giou ich kol\u00f3ni\u00ed a testovali sme ich biochemick\u00e9 vlastnosti. Pri ve\u013ekosti kol\u00f3ni\u00ed suspektn\u00fdch betahemolytick\u00fdch streptokokov &gt; 0,5 mm sme pokra\u010dovali v identifik\u00e1cii \u00a0testom PYR na d\u00f4kaz \u00a0pyrolidonylarylamid\u00e1zy, ktor\u00fd je z betahemolytick\u00fdch streptokokov pozit\u00edvny\u00a0 len pri <em>S. pyogenes<\/em>. Pri negat\u00edvnom PYR teste sme vykonali VP test (Vogesov-Proskauerov test) na detekciu aceto\u00ednu, ktor\u00fd b\u00fdva pozit\u00edvny v pr\u00edpade <em>S. agalactiae<\/em>, pri betahemolytick\u00fdch streptokokoch skup\u00edn C a G je v\u0161ak v\u017edy negat\u00edvny. V pr\u00edpade negat\u00edvneho PYR a VP testu pri betahemolytick\u00fdch streptokokoch s ve\u013ekos\u0165ou kol\u00f3ni\u00ed &gt; 0,5 mm sme ur\u010dili ich skupinov\u00fa pr\u00edslu\u0161nos\u0165 pod\u013ea Lancefieldovej met\u00f3dou latexovej aglutin\u00e1cie. \u00a0Suspektn\u00e9 kol\u00f3nie \u00a0<em>S.\u00a0 agalactiae <\/em>sme overili CAMP testom. V pr\u00edpade betahemolytick\u00fdch streptokokov s ve\u013ekos\u0165ou \u00a0kol\u00f3ni\u00ed &lt; 0,5 mm \u00a0sme vykonali VP test a v pr\u00edpade pozitivity sme ich zaradili do <em>Streptococcus anginosus group<\/em>. Sledovali \u00a0sme v\u00fdskyt \u00a0pr\u00edpadn\u00fdch atypick\u00fdch reakci\u00ed, \u00a0vtedy sme v\u017edy overili suspektn\u00e9 kol\u00f3nie betahemolytick\u00fdch streptokokov mikroskopick\u00fdm prepar\u00e1tom farben\u00fdm pod\u013ea \u00a0Grama a z\u00e1rove\u0148 sme vizu\u00e1lne \u00a0skontrolovali \u010distotu izolovanej bakteri\u00e1lnej kult\u00fary. Citlivos\u0165 kme\u0148ov \u00a0na antibiotik\u00e1 sme testovali diskovou dif\u00faznou \u00a0met\u00f3dou pod\u013ea z\u00e1sad EUCAST na kultiva\u010dnom m\u00e9diu MHF \u2013 agar pod\u013ea Muellera a Hintonovej so 7 % konskej krvi a NAD. Testovali sme citlivos\u0165 kme\u0148ov na penicil\u00edn (PEN), erytromyc\u00edn (ERY), klindamyc\u00edn \u00a0(CLI), ofloxac\u00edn (OFL), tetracykl\u00edn (TET). Inhibi\u010dn\u00e9 \u00a0z\u00f3ny \u00a0antibiot\u00edk PEN, ERY, CLI a TET sme hodnotili pod\u013ea z\u00e1sad normy EUCAST(12), inhibi\u010dn\u00fa \u00a0z\u00f3nu \u00a0OFL sme hodnotili pod\u013ea americkej normy CLSI(14). Spolu \u00a0s testom citlivosti \u00a0sme hodnotili \u00a0aj diagnostick\u00fd disk s obsahom 0,04 jednotiek bacitrac\u00ednu, ktor\u00fd bol umiestnen\u00fd na \u00a0p\u00f4du \u00a0MHF spolu s diskami na \u00a0antibiotick\u00fa citlivos\u0165. Bacitrac\u00ednov\u00fd disk sl\u00fa\u017ei ako skr\u00edningov\u00fd test na d\u00f4kaz <em>S. pyogenes<\/em>, ktor\u00fd nerastie v okol\u00ed disku s bacitrac\u00ednom (0,04 j.) Ostatn\u00e9 streptokoky bacitrac\u00edn v n\u00edzkej koncentr\u00e1cii toleruj\u00fa. \u00a0Ak je priemer \u00a0inhibi\u010dnej z\u00f3ny okolo disku \u00a0s 0,04 j. bacitrac\u00ednu \u2265 10 mm, m\u00f4\u017ee \u00a0\u00eds\u0165 o <em>S. pyogenes, <\/em>ak je priemer inhibi\u010dnej z\u00f3ny \u2264 10 mm, je pravdepodobn\u00e9, \u017ee ide o betahemolytick\u00fd streptokok inej s\u00e9rologickej skupiny.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>\u00fdsledky<\/strong><\/p>\n<p>Za obdobie od 1. 1. 2014 do 31. 12. 2015 v laborat\u00f3riu HPL spol.\u00a0 s r. o., v Kom\u00e1rne \u00a0sme vy\u0161etrili celkovo \u00a068 138 vzoriek z horn\u00fdch \u00a0d\u00fdchac\u00edch ciest \u00a0od pacientov s diagn\u00f3zami ak\u00fatneho z\u00e1palu horn\u00fdch \u00a0d\u00fdchac\u00edch ciest, z toho \u00a047 548 \u00a0v\u00fdterov hrdla a 20 588 v\u00fdterov nosa. Izolovali sme 3 900 (5,72 %) kme\u0148ov betahemolytick\u00fdch \u00a0streptokokov: 3 \u00a0729 \u00a0(5,47 \u00a0%) z \u00a0v\u00fdterov hrdla a 171 (0,25 %) z v\u00fdterov nosa. Sledovali sme v\u00fdskyt <em>S. pyogenes<\/em>, <em>S. agalactiae, <\/em>betahemolytick\u00fdch streptokokov ostatn\u00fdch skup\u00edn a mas\u00edvne n\u00e1lezy podmienene patog\u00e9nneho streptokoka <em>S. anginosus group <\/em>vo vzork\u00e1ch z horn\u00fdch d\u00fdchac\u00edch ciest \u00a0pacientov <strong><em>(tabu\u013eka 1)<\/em><\/strong>.<\/p>\n<p>Rozlo\u017eenie n\u00e1lezov betahemolytick\u00fdch streptokokov v na\u0161om s\u00fabore zn\u00e1zor\u0148uje <strong><em>graf 1<\/em><\/strong>.<\/p>\n<p>Vo v\u00fdskyte \u00a0betahemolytick\u00fdch streptokokov sme zaznamenali v\u00fdrazn\u00fa \u00a0sezonalitu. Streptokokov\u00e9 n\u00e1kazy horn\u00fdch d\u00fdchac\u00edch ciest boli \u00a0naj\u010dastej\u0161ie v jesenn\u00fdch a \u00a0zimn\u00fdch mesiacoch, v jarn\u00fdch \u00a0mesiacoch ich v\u00fdskyt poklesol a v lete dosahoval najni\u017e\u0161ie hodnoty. V\u00fdskyt betahemolytick\u00fdch\u00a0streptokokov v jednotliv\u00fdch mesiacoch uv\u00e1dzame v <strong><em>tabu\u013eke\u00a0<\/em><\/strong><strong><em>2<\/em><\/strong>. Sezon\u00e1lny v\u00fdskyt jednotliv\u00fdch druhov betahemolytick\u00fdch streptokokov je zn\u00e1zornen\u00fd na <strong><em>grafe 2<\/em>\u00a0<\/strong><em style=\"font-size: inherit;\">pyogenes <\/em><span style=\"font-size: inherit;\">(HSA) sa vyskytoval naj\u010dastej\u0161ie v obdob\u00ed od okt\u00f3bra do decembra s vrcholom v\u00fdskytu v novembri. V\u00fdskyt betahemolytick\u00fdch streptokokov sk. C a G kulminoval v jesenn\u00fdch mesiacoch, najm\u00e4 \u00a0v septembri a novembri. <\/span><em style=\"font-size: inherit;\">S. aga<\/em><em style=\"font-size: inherit;\">lactiae \u00a0<\/em><span style=\"font-size: inherit;\">sa vyskytoval \u00a0preva\u017ene v jarn\u00fdch, k\u00fdm <\/span><em style=\"font-size: inherit;\">S. anginosus group <\/em><span style=\"font-size: inherit;\">v zimn\u00fdch mesiacoch.<\/span><\/p>\n<p>Sledovali \u00a0sme v\u00fdskyt betahemolytick\u00fdch streptokokov aj v jednotliv\u00fdch \u00a0vekov\u00fdch \u00a0kateg\u00f3ri\u00e1ch. Zistili sme najv\u00e4\u010d\u0161iu vn\u00edmavos\u0165 na\u00a0 infekciu \u00a0<em>S. pyogenes <\/em>u det\u00ed \u00a0vo veku od 7 do 11 rokov, t. j. v mlad\u0161om \u0161kolskom veku. V\u00fdskyt jednotliv\u00fdch druhov betahemolytick\u00fdch streptokokov pod\u013ea vekov\u00fdch kateg\u00f3ri\u00ed zn\u00e1zor\u0148uje <strong><em>tabu\u013eka 3<\/em><\/strong>.<\/p>\n<p>Percentu\u00e1lne zast\u00fapenie \u00a0rezistentn\u00fdch kme\u0148ov na \u00a0testovan\u00e9 antimikrobi\u00e1lne l\u00e1tky klindamyc\u00edn \u00a0(CLI), erytromyc\u00edn (ERY), ofloxac\u00edn (OFL), penicil\u00edn (PEN), tetracykl\u00edn (TET) zn\u00e1zor\u0148uje \u00a0<strong><em>tabu\u013eka 4<\/em><\/strong>.<\/p>\n<p><strong>Diskusia<\/strong><\/p>\n<p>Betahemolytick\u00e9 \u00a0streptokoky s\u00fa v\u00fdznamn\u00fdmi p\u00f4vodcami bakteri\u00e1lnych infekci\u00ed horn\u00fdch d\u00fdchac\u00edch ciest, z nich najv\u00fdznamnej\u0161\u00ed je <em>Streptococcus pyogenes, <\/em>prim\u00e1rny patog\u00e9n, p\u00f4vodca bakteri\u00e1lnej tonzilofaryngit\u00eddy. V literat\u00fare sa uv\u00e1dza, \u017ee <em>S. pyogenes <\/em>b\u00fdva etiologick\u00fdm faktorom tohto ochorenia v 5 a\u017e 17 % pr\u00edpadov infekcie u dospel\u00fdch(6) a v 20 a\u017e 30 % pr\u00edpadov \u00a0tonzilofaryngit\u00eddy u det\u00ed(7). Tieto v\u00fdsledky vypl\u00fdvaj\u00fa z cielen\u00fdch \u0161t\u00fadi\u00ed zalo\u017een\u00fdch na d\u00f4kladnom v\u00fdbere pacientov na z\u00e1klade klinick\u00fdch pr\u00edznakov. Ke\u010f\u017ee klinick\u00e1 symptomatol\u00f3gia \u00a0streptokokovej tonzilofaryngit\u00eddy nie je v\u017edy typick\u00e1, do na\u0161ej \u0161t\u00fadie sme zaradili v\u0161etk\u00fdch pacientov, ktor\u00ed mali diagn\u00f3zu ak\u00fatneho z\u00e1palu v oblasti horn\u00fdch d\u00fdchac\u00edch ciest. V na\u0161om s\u00fabore sme zistili streptokokov\u00fa etiol\u00f3giu u 5,72 % pacientov prejavuj\u00facich pr\u00edznaky\u00a0 ak\u00fatneho z\u00e1palu horn\u00fdch d\u00fdchac\u00edch ciest \u00a0s najvy\u0161\u0161\u00edm podielom <em>S. pyogenes <\/em>(2,22 %). Bli\u017e\u0161ou \u00a0anal\u00fdzou v\u00fdsledkov \u00a0sme zistili, \u017ee t\u00e1to bakt\u00e9ria sa podie\u013ea \u00a0na \u00a038,69 \u00a0% v\u0161etk\u00fdch tonzilofaryngit\u00edd vyvolan\u00fdch betahemolytick\u00fdmi streptokokmi a naj\u010dastej\u0161ie sa vyskytuje u det\u00ed vo vekovej skupine 7 a\u017e 11 rokov, kde sp\u00f4sobuje a\u017e 16,51 % faryngit\u00edd streptokokovej etiol\u00f3gie.<\/p>\n<p>Betahemolytick\u00e9 streptokoky in\u00fdch skup\u00edn \u00a0ako A, preva\u017ene B, C a G m\u00f4\u017eu \u00a0sp\u00f4sobova\u0165 klinick\u00fd obraz podobn\u00fd ako pri tonzilofaryngit\u00edde vyvolanej <em>S. pyogenes<\/em>. Tiemstra a kol. (8) vykonali retrospekt\u00edvnu anal\u00fdzu \u00a0priebehu ochorenia 915 pacientov, ktor\u00ed nav\u0161t\u00edvili praktick\u00e9ho lek\u00e1ra pre bolesti hrdla s klinick\u00fdmi pr\u00edznakmi streptokokovej \u00a0faryngit\u00eddy. \u00a0H\u013eadali zhodu \u00a0alebo \u00a0odli\u0161nosti klinick\u00fdch pr\u00edznakov \u00a0v z\u00e1vislosti od druhu \u00a0izolovan\u00e9ho \u00a0betahemolytick\u00e9ho \u00a0streptokoka. Z 915 pacientov 63 \u00a0% malo \u00a0negat\u00edvny bakteriologick\u00fd kultiva\u010dn\u00fd n\u00e1lez, \u00a0pr\u00edtomnos\u0165 \u00a0<em>S. pyogenes <\/em>potvrdili \u00a0u 16 \u00a0% pacientov, betahemolytick\u00fd streptokok sk. \u00a0C bol izolovan\u00fd \u00a0u 9 %, sk. B u 6 %, sk. G u 4 %, sk. F u 1 % a netypovate\u013en\u00e9 betahemolytick\u00e9 streptokoky u 1 % pacientov. Zistili, \u017ee boles\u0165 hlavy, zv\u00fd\u0161en\u00e1 teplota, faryng\u00e1lny \u00a0exud\u00e1t a kr\u010dn\u00e1 lymfadenopatia s\u00fa pr\u00edznaky \u00a0typick\u00e9 \u00a0pri streptokokovej faryngit\u00edde bez \u00a0oh\u013eadu na druh \u00a0vyvol\u00e1vate\u013ea.<\/p>\n<p>Vekov\u00fd priemer pacientov bol 26 rokov. V na\u0161om s\u00fabore dospel\u00fdch pacientov sa tie\u017e \u00a0potvrdilo najvy\u0161\u0161ie percentu\u00e1lne zast\u00fapenie <em>S. pyogenes <\/em>pri faryngit\u00eddach streptokokovej etiol\u00f3gie (8,51 %). Betahemolytick\u00e9 streptokoky sk. B a C (4,95 %, 4,44 %) boli zast\u00fapen\u00e9 pribli\u017ene v rovnakom pomere a sk. G bola dok\u00e1zan\u00e1 v n\u00edzkom percente (1,85 %). Faryngit\u00eddy sp\u00f4soben\u00e9 in\u00fdmi betahemolytick\u00fdmi streptokokmi ako \u00a0<em>S. pyogenes <\/em>je odpor\u00fa\u010dan\u00e9 prelie\u010di\u0165 antibiotikami v z\u00e1ujme skor\u0161ieho uzdravenia a pre zn\u00ed\u017eenie rizika \u0161\u00edrenia infekcie na \u013eud\u00ed v bl\u00edzkosti pacienta. Osobitne d\u00f4le\u017eit\u00e9 je zamedzi\u0165 \u0161\u00edrenie \u00a0infekcie \u00a0v pr\u00edtomnosti imunosuprimova- n\u00fdch \u013eud\u00ed, tehotn\u00fdch \u017eien a novorodencov v dom\u00e1cnosti chor\u00e9ho(8). V pr\u00edpade betahemolytick\u00fdch streptokokov skupiny C existuje ur\u010dit\u00e9, s\u00edce \u00a0ve\u013emi n\u00edzke, riziko vzniku postinfek\u010dnej glomerulonefrit\u00eddy. V literat\u00fare sa opisuje najm\u00e4 \u00a0v s\u00favislosti s n\u00e1lezom betahemolytick\u00e9ho streptokoka skupiny C zvieracieho p\u00f4vodu <em>Streptococcus equi subspecies zooepidemicus <\/em>nielen po syst\u00e9movej infekcii(9), ale aj v s\u00favislosti s n\u00e1lezom vo v\u00fdteroch \u00a0z hrdla pacientov(10). <em>S. anginosus group <\/em>je skupina betahemolytick\u00fdch streptokokov, ktor\u00fdch \u00a0niektor\u00ed\u00a0 pr\u00edslu\u0161n\u00edci maj\u00fa potenci\u00e1l sp\u00f4sobova\u0165 faryngit\u00eddu \u00a0alebo \u00a0stav spojen\u00fd s boles\u0165ami hrdla. V poslednom obdob\u00ed \u00a0vyu\u017eit\u00edm modern\u00fdch met\u00f3d molekul\u00e1rnej biol\u00f3gie je snaha zrevidova\u0165 taxon\u00f3miu <em>S. anginosus group <\/em>s osobitn\u00fdm d\u00f4razom na odl\u00ed\u0161enie betahemolytick\u00fdch kme\u0148ov patriacich do Lancefieldovej skupiny C, medzi \u00a0ktor\u00fdmi s\u00fa\u00a0 p\u00f4vodcovia faryngit\u00edd(11). Ke\u010f\u017ee v podmienkach rutinn\u00fdch laborat\u00f3ri\u00ed nie je mo\u017enos\u0165 presnej druhovej identifik\u00e1cie izolovan\u00fdch kme\u0148ov \u00a0<em>S. anginosus group <\/em>a stanovenie skupinovej pr\u00edslu\u0161nosti je problematick\u00e9 z d\u00f4vodu slab\u00e9ho n\u00e1rastu izolovan\u00fdch kme\u0148ov, do \u0161t\u00fadie sme zaradili v\u0161etky mas\u00edvne n\u00e1lezy tejto skupiny betahemolytick\u00fdch streptokokov pri z\u00e1palov\u00fdch diagn\u00f3zach horn\u00fdch \u00a0d\u00fdchac\u00edch ciest. Najviac tak\u00fdchto n\u00e1lezov sme zaznamenali v skupine dospel\u00fdch pacientov, kde tvorili 20,92 % betahemolytick\u00fdch streptokokov izolovan\u00fdch od pacientov tejto vekovej skupiny.<\/p>\n<p>Vo v\u00fdskyte \u00a0streptokokov\u00fdch infekci\u00ed \u00a0horn\u00fdch \u00a0d\u00fdchac\u00edch ciest sme zaznamenali sezonalitu s naj\u010dastej\u0161\u00edm v\u00fdskytom v jesenn\u00fdch a zimn\u00fdch mesiacoch, s poklesom v jarn\u00fdch mesiacoch a s najni\u017e\u0161\u00edm v\u00fdskytom \u00a0po\u010das leta.<\/p>\n<p>Betahemolytick\u00e9 streptokoky s\u00fa \u00a0st\u00e1le stopercentne citliv\u00e9 na penicil\u00edn, v ambulantnej lie\u010dbe \u00a0je peror\u00e1lny fenoxymetylpenicil\u00edn liekom vo\u013eby. V\u00fdnimkou je <em>S. agalactiae, \u00a0<\/em>v pr\u00edpade ktor\u00e9ho eur\u00f3pska norma na testovanie citlivosti EUCAST neobsahuje interpreta\u010dn\u00e9 krit\u00e9ri\u00e1 fenoxymetylpenicil\u00ednu, pou\u017eitie tohto antibiotika v lie\u010dbe infekci\u00ed sp\u00f4soben\u00fdch <em>S. aga<\/em><em>lactiae \u00a0<\/em>preto \u00a0nie je odpor\u00fa\u010dan\u00e9(12). Vhodnej\u0161ie s\u00fa \u00a0in\u00e9 penicil\u00ednov\u00e9 \u00a0antibiotik\u00e1 alebo \u00a0cefalospor\u00edny 1. a \u00a02. gener\u00e1cie. U pacientov alergick\u00fdch na penicil\u00edn v lie\u010dbe streptokokov\u00fdch infekci\u00ed s\u00fa \u00a0alternat\u00edvnou vo\u013ebou makrolidov\u00e9 alebo \u00a0linkozamidov\u00e9 antibiotik\u00e1, pr\u00edpadne cefalospor\u00edny 1. a 2. gener\u00e1cie. N\u00e1rast rezistencie na makrolidy v r\u00e1mci Slovenskej republiky je pozorovan\u00fd od roku 2001, vtedy bola zaznamenan\u00e1 rezistencia v 19 % kme\u0148ov <em>S. pyogenes<\/em>. V roku 2010 priemern\u00e1 rezistencia kme\u0148ov <em>S. pyogenes <\/em>na makrolidy bola 32,5 %, v rokoch 2012 \u2013 2013 sa pohybovala v rozmedz\u00ed 29 \u2013 30 % (13). V na\u0161om s\u00fabore sme zaznamenali 16 % rezistenciu <em>S. pyoge<\/em><em>nes <\/em>na makrolidov\u00e9 antibiotik\u00e1. V pr\u00edpade <em>S. agalactiae \u00a0<\/em>sme zaznamenali 36 % rezistenciu na makrolidy, pri betahemolytick\u00fdch streptokokoch sk. C bolo 25 % kme\u0148ov rezistentn\u00fdch na makrolidov\u00e9 antibiotik\u00e1 a pri betahemolytick\u00fdch streptokokoch skupiny G bola rezistencia a\u017e 41 %. V pr\u00edpade linkozamidov bola miera \u00a0rezistencie podobn\u00e1 ako pri makrolidoch. Pozoruhodn\u00e1 bola rezistencia <em>S. agalactiae \u00a0<\/em>na tetracykl\u00ednov\u00e9 antibiotik\u00e1, ktor\u00e1 dosahovala 69 %. Testovan\u00e9 kmene boli citliv\u00e9 na z\u00e1stupcu fluorovan\u00fdch chinol\u00f3nov ofloxac\u00edn, ktor\u00e9ho citlivos\u0165 sme interpretovali pod\u013ea z\u00e1sad americkej normy CLSI(14).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z\u00e1ver<\/strong><\/p>\n<p>V na\u0161om s\u00fabore bol <em>S. pyogenes <\/em>dominantn\u00fdm p\u00f4vodcom bakteri\u00e1lnej tonzilofaryngit\u00eddy u det\u00ed \u00a0v mlad\u0161om \u0161kolskom veku. Liekom vo\u013eby t\u00fdchto \u00a0infekci\u00ed ost\u00e1va na\u010falej fenoxymetylpenicil\u00edn. Rezistencia na makrolidov\u00e9 a linkozamidov\u00e9 \u00a0antibiotik\u00e1 bola \u00a0v na\u0161om s\u00fabore najni\u017e\u0161ia pri kme\u0148och <em>S. pyogenes<\/em>. Zriedkavej\u0161\u00ed bol v\u00fdskyt betahemolytick\u00fdch streptokokov sk. C a G, pri ktor\u00fdch \u00a0je takisto stopercentn\u00e1 citlivos\u0165 \u00a0na \u00a0penicil\u00edn, \u00a0zaznamenali sme v\u0161ak \u00a0v\u00fdrazne \u00a0vy\u0161\u0161iu rezistenciu na makrolidov\u00e9 a linkozamidov\u00e9 antibiotik\u00e1. V pr\u00edpade <em>S. agalactiae <\/em>sa lie\u010dba fenoxymetylpenicil\u00ednom neodpor\u00fa\u010da, liekom vo\u013eby s\u00fa in\u00e9 penicil\u00ednov\u00e9 antibiotik\u00e1 alebo cefalospor\u00edny. Vzh\u013eadom \u00a0na tieto \u00a0zistenia je na mieste zd\u00f4razni\u0165 d\u00f4le\u017eitos\u0165 mikrobiologickej kultiva\u010dnej \u00a0anal\u00fdzy \u00a0s ur\u010den\u00edm \u00a0druhu a\/alebo skupinovej \u00a0pr\u00edslu\u0161nosti betahemolytick\u00e9ho streptokoka a citlivosti na antibiotik\u00e1, aby v pr\u00edpade potreby pacienti dost\u00e1vali indikovan\u00fa \u00a0a cielen\u00fa lie\u010dbu bakteri\u00e1lnej tonzilofaryngit\u00eddy.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Literat\u00fara<\/strong><br \/>\n1. Syrjanen RK, et al. Nasopharyngeal carriage of Streptococcus pneumoniae in Finnish children younger than 2 years old. The Journal of Infectious Diseases 2001; 184: 451-459.<br \/>\n2. Bogaert D, de Groot R, Hermans PWM Streptococcus pneumoniae colonisation: the key to pneumococcal disease. The Lancet Infectious Diseases 2004; 4: 144-154.<br \/>\n3. McCullers JA, Insights into the interaction between influenza virus and pneumococcus. Clinical Microbiology Reviews 2006; 19: 571-582.<br \/>\n4. Astrid A, et al. Viral and Bacterial Interactions in the Upper Respiratory Tract. Plos Pathogens 2013; 9(1): e1003057.<br \/>\n5. Regev-Yochay G, et al. Is nasopharyngeal carriage of Streotococcus pneumoniae protective against carriage of Staphylococcus aureus? 43rd ICCAC; Chicago; sept 14-17, 2003, abstr. G-2048.<br \/>\n6. Pericone CD, et al. Inhibitory and bactericidal effects of hydrogen peroxide production by Streptococcus pneumoniae on other inhabitants of the upper respiratory tract. Infection and Imunity 2000; 68(7): 3990-3997.<br \/>\n7. Shakhnovich EA, King SJ, Weiser JN Neuraminidase expressed by streptococcus pneumoniae desialylates the lipopolysaccharide of Neisseria meningitidis and Haemophilus influenzae: A paradigm for interbacterial<br \/>\ncompetition among pathogens of the human respiratory tract. Infection and Imunity 2002; 70(12): 7161-7164.<br \/>\n8. Perez AC, Pang B, King LB, et al. Residence of Streptococcus pneumoniae and Moraxella catarrhalis within polymicrobial biofilm promotes antibiotic resistance and bacterial persistence in vivo. Pathogens and disease<br \/>\n2014; 70(3): 280-288.<br \/>\n9. Tomasz A. Antibiotic resistence in Streptococcus pneumoniae. Clinical Infectious Diseases 1997; 24(Suppl 1): S85-8.<br \/>\n10. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters Version 4.0, valid from 2014-01-01, Dostupn\u00e9 na http:\/\/www.eucast.org\/<br \/>\n11. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters Version 5.0, valid from 2015-01-01, Dostupn\u00e9 na http:\/\/www.eucast.org\/<br \/>\n12. Stacevi\u010diene I, et al. Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschol children with acute respiratory tract infection in Lithuana. BMC Infectious Diseases 2016; 16: 216.<br \/>\n13. Ferreira LM, et al. Nasopharyngeal colonisation and antimicrobial resistance of Streptococcus pneumoniae isolated from children with acute rhinopharyngitis. Journal de Pediatria 2001; 77(3): 227-234.<br \/>\n14. Kumar KLR, et al. Nasopharyngeal carriage, antibiogram &amp; serotype distribution of Streptococcus pneumoniae among healthy under five children. Indian J Med Res 2014; 140: 216-220.<br \/>\n15. Luminos M, et al. Nasopharyngeal carriage of Streptococcus pneumoniae in Romanian children before the introduction of the pneumococcal conjugated vaccination into the national immunization programe: a national, multicentre, 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 Streptococcus pneumoniae circulating in pediatric hospitals in Moscow, Russia. 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. Prim\u00e1rny kontakt 2014; 2(6): 14-16.<br \/>\n18. Performance standards for antimicrobial susceptibility testing, twenty fourth informational supplement, CLSI 2014; M100-S24<br \/>\n19. Performance standards for antimicrobial susceptibility testing , twenty fourth informational supplement, CLSI 2015; M100-S25<br \/>\n20. Liofilchem\u00ae \u2013 MIC Test Strip Technical Sheet Streptococcus pneumoniae &#8211; MTS23 Rev.6<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; \u00davod S. pneumoniae je bakt\u00e9ria ktor\u00e1 \u010dasto os\u00edd\u013euje sliznice horn\u00fdch d\u00fdchac\u00edch ciest. Z asymptomatickej koloniz\u00e1cie sa v\u0161ak m\u00f4\u017ee vyvin\u00fa\u0165 ochorenie d\u00fdchac\u00edch ciest ale aj invaz\u00edvna infekcia. Nazofaryng\u00e1lne nosi\u010dstvo pneumokokov<\/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":[620,624,623,622,621],"class_list":["post-1023","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-beta-hemolytic-streptococci","tag-macrolides","tag-penicillin","tag-pharyngitis","tag-tonsillitis","typ_clanku-original-work"],"acf":{"abstrakt":"<p>The objective of our paper was to monitor the prevalence of beta-hemolytic streptococci in smears from z upper airways of patients diagnosed with acute inflammation of upper airways in the district of Kom\u00e1rno and Nov\u00e9 Z\u00e1mky between Jan 1<sup>st<\/sup>, 2014 and Dec 31<sup>st,<\/sup> 2015. During this period, we isolated 3 900 (5.72 %) phyla of beta-hemolytic streptococci: 3 729 (5.47 %) from throat smears and 171 (0.25 %) from nasal smears. The mutual ratio of beta-hemolytic streptococci was as follows: 38.69 % S. pyogenes, 11.74 % S. agalactiae 13.05 % beta-hemolytic streptococci of groups C and G, 4.80 % non-specific type beta-hemolytic streptococci and 31.72 % for the S. anginosus group. Streptococcal infections of upper airways were most prevalent during the autumn and winter months, the ratio decreased during spring and reached the lowest levels in summer. Children aged 7 to 11 showed the highest level of susceptibility to S. pyogenes infection, while the prevalence of other species of beta-hemolytic streptococci was highest among adults. Phenoxymethylpenicillin continues to be the therapy of choice for these infections (with the exception of S. agalactiae infections), resistance to macrolide-based and lincosamide antibiotics is between 15 and 43 %.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Key words:<\/strong> beta-hemolytic streptococci, tonsillitis, pharyngitis, penicillin, macrolides<\/p>\n<p>&nbsp;<\/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":"25","upload_clanok":{"ID":949,"id":949,"title":"V\u00fdskyt betahemolytick\u00fdch streptokokov izolovan\u00fdch z horn\u00fdch d\u00fdchac\u00edch ciest pacientov z okresov Kom\u00e1rno a Nov\u00e9 Z\u00e1mky","filename":"V\u00fdskyt-betahemolytick\u00fdch-streptokokov-izolovan\u00fdch-z-horn\u00fdch-d\u00fdchac\u00edch-ciest-pacientov-z-okresov-Kom\u00e1rno-a-Nov\u00e9-Z\u00e1mky.pdf","filesize":876932,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/04\/V\u00fdskyt-betahemolytick\u00fdch-streptokokov-izolovan\u00fdch-z-horn\u00fdch-d\u00fdchac\u00edch-ciest-pacientov-z-okresov-Kom\u00e1rno-a-Nov\u00e9-Z\u00e1mky.pdf","link":"https:\/\/www.newslab.sk\/en\/prevalence-of-beta-hemolytic-streptococci-isolated-from-upper-airways-of-patients-in-the-districts-of-komarno-and-nove-zamky-and-their-resistance-to-antibiotics\/vyskyt-betahemolytickych-streptokokov-izolovanych-z-hornych-dychacich-ciest-pacientov-z-okresov-komarno-a-nove-zamky-2\/","alt":"","author":"7","description":"","caption":"","name":"vyskyt-betahemolytickych-streptokokov-izolovanych-z-hornych-dychacich-ciest-pacientov-z-okresov-komarno-a-nove-zamky-2","status":"inherit","uploaded_to":1023,"date":"2017-04-06 20:29:27","modified":"2017-04-06 20:29:27","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\/1023","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=1023"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1023\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1023"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1023"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1023"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}