{"id":1786,"date":"2015-04-12T18:01:06","date_gmt":"2015-04-12T17:01:06","guid":{"rendered":"http:\/\/slanedeti.sk\/cms\/?p=1786"},"modified":"2017-03-07T10:14:22","modified_gmt":"2017-03-07T09:14:22","slug":"rezistencia-antibiotik-a-cysticka-fibroza","status":"publish","type":"post","link":"https:\/\/slanedeti.sk\/cms\/rezistencia-antibiotik-a-cysticka-fibroza\/1786","title":{"rendered":"Rezistencia antibiot\u00edk a cystick\u00e1 fibr\u00f3za"},"content":{"rendered":"

Rezistencia antibiot\u00edk\u00a0(Antimicrobial Resistance, AMR) je roz\u0161\u00edren\u00fd jav, pri ktorom antibiotik\u00e1 prest\u00e1vaj\u00fa by\u0165 \u00fa\u010dinn\u00e9 (citliv\u00e9) na lie\u010dbu p\u00f4vodcov infek\u010dn\u00fdch ochoren\u00ed, bakt\u00e9rie nadob\u00fadaj\u00fa vo\u010di antibiotik\u00e1m odolnos\u0165. Rezistencia s\u00edce nie je \u017eiadna nov\u00e1 skuto\u010dnos\u0165, ale jej v\u00fdznam z viacer\u00fdch d\u00f4vodov narast\u00e1. Jednak sa neust\u00e1le zvy\u0161uje jej celkov\u00fd rozsah a na druhej strane neboli objaven\u00e9 nov\u00e9 antibiotik\u00e1, ktor\u00e9 by mohli by\u0165 nasaden\u00e9 namiesto t\u00fdch, vo\u010di ktor\u00fdm sa vyvinula rezistencia antibiot\u00edk.<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n
Antibiotikum<\/strong><\/td>\nObjav<\/strong><\/td>\nUveden\u00e9 do klinickej praxe<\/strong><\/td>\nObjav rezistencie<\/strong><\/td>\n<\/tr>\n
Penicil\u00edn<\/td>\n1928<\/td>\n1943<\/td>\n1940<\/td>\n<\/tr>\n
Streptomyc\u00edn<\/td>\n1944<\/td>\n1947<\/td>\n1959<\/td>\n<\/tr>\n
Tetracykl\u00edn<\/td>\n1948<\/td>\n1952<\/td>\n1953<\/td>\n<\/tr>\n
Erytromyc\u00edn<\/td>\n1952<\/td>\n1955<\/td>\n1956<\/td>\n<\/tr>\n
Vankomyc\u00edn<\/td>\n1956<\/td>\n1972<\/td>\n1987<\/td>\n<\/tr>\n
Gentamyc\u00edn<\/td>\n1963<\/td>\n1967<\/td>\n1970<\/td>\n<\/tr>\n
Linezolid<\/td>\n1996<\/td>\n2000<\/td>\n2001<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

Mechanizmus \u0161\u00edrenia rezistencie spo\u010d\u00edva v g\u00e9noch, ktor\u00e9 ochr\u00e1nia bakt\u00e9riu pred \u00fa\u010dinkom antibiotika. T\u00fdchto g\u00e9nov je ve\u013ek\u00e9 mno\u017estvo a v\u010faka tzv. plazmidom (kr\u00e1tke \u00faseky DNA, ktor\u00e9 nie s\u00fa s\u00fa\u010das\u0165ou bunkov\u00e9ho jadra a bakt\u00e9rie si ich m\u00f4\u017eu navz\u00e1jom vymie\u0148a\u0165) sa m\u00f4\u017eu pomerne r\u00fdchlo \u0161\u00edri\u0165 aj medzi r\u00f4znymi druhmi bakt\u00e9rii. V prostred\u00ed s antibiotikom teda bakt\u00e9rie bez g\u00e9nov pre rezistenciu zahyn\u00fa, v\u00fdsledkom selekcie je, \u017ee pre\u017eij\u00fa iba rezistentn\u00e9 bakt\u00e9rie a ich \u010fal\u0161ie gener\u00e1cie si zachovaj\u00fa rezistenciu – proces \u0161\u00edrenia rezistencie je podmienen\u00fd evolu\u010dne. Bakt\u00e9rie m\u00f4\u017eu ma\u0165 viac r\u00f4znych g\u00e9nov pre rezistenciu vo\u010di viacer\u00fdm antibiotik\u00e1m (\u010do je aj pomerne be\u017en\u00e9), v tomto pr\u00edpade hovor\u00edme o multirezistencii. Jednotliv\u00e9 g\u00e9ny (resp. enz\u00fdmy ktor\u00e9 dan\u00e9 g\u00e9ny k\u00f3duj\u00fa) m\u00f4\u017eu zabezpe\u010dova\u0165 rezistenciu r\u00f4znymi mechanizmami (napr\u00edklad chemicky rozlo\u017eia molekulu antibiotika, zabr\u00e1nia jeho vzniku do bakteri\u00e1lnej bunky, zabezpe\u010dia vyl\u00fa\u010denie antibiotika z bakteri\u00e1lnej bunky, zmenia metabolick\u00e9 dr\u00e1hy tak, \u017ee do nich antibiotikum nevstupuje).<\/p>\n

Pod\u013ea toho ak\u00fd g\u00e9n pre rezistenciu, alebo kombin\u00e1cia g\u00e9nov, je v bakteri\u00e1lnej bunke, nemus\u00ed by\u0165 rezistencia \u00fapln\u00e1, ale iba zn\u00ed\u017ei citlivos\u0165 vo\u010di antibiotiku (\u201cintermedi\u00e1rna citlivos\u0165\u201c, skratka \u201cI\u201c). Aj preto je pou\u017e\u00edvan\u00e1 hodnota MIC (Minimum Inhibitiry Concentration) \u2013 minim\u00e1lna inhibi\u010dn\u00e1 koncentr\u00e1cia, ktor\u00e1 ur\u010duje ak\u00e1 koncentr\u00e1cia antibiotika je potrebn\u00e1 na zastavenie rastu pri laborat\u00f3rnej kultiv\u00e1cii. Tieto hodnoty sa \u0161tandardne uv\u00e1dzaj\u00fa pri mikrobiologick\u00fdch vy\u0161etreniach. \u010c\u00edm je hodnota vy\u0161\u0161ia, t\u00fdm viac antibiotika je potrebn\u00e9ho na zastavenie rastu bakt\u00e9rii, resp. lie\u010dbu infekcie, t\u00fdm je bakt\u00e9ria pre dan\u00e9 antibiotikum rezistentnej\u0161ia.<\/p>\n

Evolu\u010dn\u00fd charakter \u0161\u00edrenia rezistencie je tie\u017e odpove\u010fou pre\u010do je rezistenciu \u0165a\u017ek\u00e9 eliminova\u0165 \u2013 DNA z plazmidov sa m\u00f4\u017ee integrova\u0165 do bunkov\u00e9ho jadra a potom sa pren\u00e1\u0161a na v\u0161etky nasleduj\u00face bakteri\u00e1lne gener\u00e1cie. Ke\u010f sa v\u0161ak niektor\u00e9 antibiotikum prestane v klinickej praxi pou\u017e\u00edva\u0165, s odstupom \u010dasu predsa len doch\u00e1dza k pozvo\u013en\u00e9mu zni\u017eovaniu rezistencie vo\u010di nemu. G\u00e9ny ktor\u00e9 neprin\u00e1\u0161aj\u00fa nosite\u013eovi \u2013 bakt\u00e9rii \u017eiadnu v\u00fdhodu pre pre\u017eitie sa s\u00edce pomaly, ale predsa z bakteri\u00e1lnej popul\u00e1cie vytr\u00e1caj\u00fa. Jeden g\u00e9n spravidla zabezpe\u010d\u00ed bakt\u00e9rii rezistenciu vo\u010di viacer\u00fdm, chemicky pr\u00edbuzn\u00fdm antibiotik\u00e1m, \u010do sa ozna\u010duje ako skr\u00ed\u017een\u00e1 rezistencia. Napr\u00edklad ak je bakt\u00e9ria rezistentn\u00e1 vo\u010di erytromyc\u00ednu (ktor\u00fd sa spravidla pou\u017e\u00edva pri laborat\u00f3rnych testoch), bude to znamena\u0165 rezistenciu aj vo\u010di ostatn\u00fdm makrolidov\u00fdm antibiotik\u00e1m (napr\u00edklad terapeuticky \u010dasto pou\u017e\u00edvan\u00e9mu azitromyc\u00ednu).<\/p>\n

Miera rezistencie je preto dobr\u00fdm obrazom ak\u00e9 antibiotik\u00e1 sa kde a kedy najviac pou\u017e\u00edvaj\u00fa. Preto napr\u00edklad kles\u00e1 rezistencia vo\u010di sulf\u00f3namidom, ke\u010f\u017ee sa v klinickej praxi u\u017e menej pou\u017e\u00edvaj\u00fa, alebo naopak je n\u00edzka rezistencia vo\u010di nov\u00fdm a drah\u00fdm antibiotik\u00e1m (napr. linezolidu) v rozvojov\u00fdch krajin\u00e1ch, napriek tomu, \u017ee pri mno\u017estve antibiot\u00edk je v dan\u00fdch krajin\u00e1ch rezistencia vysok\u00e1. Z poh\u013eadu geografick\u00e9ho roz\u0161\u00edrenia celkovej, alebo priemernej rezistencie je mo\u017en\u00e9 vytvori\u0165 ur\u010dit\u00e9, ve\u013emi pribli\u017en\u00e9 zov\u0161eobecnenia. Charakter rezistencie ur\u010duje vo ve\u013ekej miere \u00a0spotreba antibiot\u00edk a spravidla je mo\u017en\u00e9 pozorova\u0165 ur\u010dit\u00fd vz\u0165ah medzi \u00farov\u0148ou zdravotn\u00edctva a antibiotickou rezistenciou. V r\u00e1mci Eur\u00f3py je najni\u017e\u0161ia rezistencia v seversk\u00fdch krajin\u00e1ch, naopak vy\u0161\u0161ia je v ju\u017enej a v\u00fdchodnej Eur\u00f3pe. Podobne z celosvetov\u00e9ho poh\u013eadu je miera rezistencie n\u00edzka v USA (pribli\u017ene na \u00farovni Eur\u00f3py), oproti tomu situ\u00e1cia je najhor\u0161ia v rozvojov\u00fdch krajin\u00e1ch. Preto aj cestovanie do oblast\u00ed s vysokou mierou rezistencie m\u00f4\u017ee pre ohrozen\u00e9 osoby predstavova\u0165 zdravotn\u00e9 riziko \u2013 mo\u017enos\u0165 infekcie multirezistentn\u00fdmi kme\u0148mi.<\/p>\n

Rezistencia antibiot\u00edk bola a\u017e pribli\u017ene do 90-tych rokov minul\u00e9ho storo\u010dia sk\u00f4r okrajov\u00fdm probl\u00e9mom. Dovtedy v\u00fdvoj nov\u00fdch antibiot\u00edk dr\u017eal krok s rozvojom rezistencie. Po\u010det nov\u00fdch antibiot\u00edk uveden\u00fdch na trh sa postupne za\u010dal zni\u017eova\u0165, niektor\u00e9 antibiotik\u00e1 boli tie\u017e stiahnut\u00e9 z trhu kv\u00f4li ne\u017eiad\u00facim \u00fa\u010dinkom (napr. temafloxacin, gatifloxacin). Prevl\u00e1da n\u00e1zor, \u00a0\u017ee hlavn\u00fdm d\u00f4vodom nedostatku nov\u00fdch antibiot\u00edk je, \u017ee v\u0161etky d\u00f4le\u017eit\u00e9 antibiotik\u00e1 u\u017e boli objaven\u00e9 a teda zvrat v podobe v\u00fdvoja nov\u00fdch molek\u00fal ani nie je mo\u017en\u00e9 o\u010dak\u00e1va\u0165. Za\u010dalo by\u0165 zrejm\u00e9, \u017ee nov\u00e1 situ\u00e1cia si vy\u017eaduje nov\u00e9 strat\u00e9gie, ktor\u00e9 by dok\u00e1zali rie\u0161i\u0165 vyn\u00e1raj\u00faci sa kritick\u00fd probl\u00e9m \u2013 mo\u017enos\u0165, \u017ee antibiotik\u00e1 prestan\u00fa by\u0165 efekt\u00edvnou antimikrobi\u00e1lnou lie\u010dbou, \u010do sa tie\u017e ozna\u010duje ako \u201cpostantibiotick\u00e1 \u00e9ra\u201c. V skuto\u010dnosti antibiotik\u00e1 nie s\u00fa jedin\u00fdmi antiinfek\u010dn\u00fdmi lie\u010divami, alternat\u00edvou m\u00f4\u017ee by\u0165 v\u00fdvoj nov\u00fdch vakc\u00edn a tie\u017e modern\u00e9 lieky vyu\u017e\u00edvaj\u00face monoklon\u00e1lne protil\u00e1tky. V s\u00fa\u010dasnosti prebieha tie\u017e v\u00fdskum na v\u00fdvoji vakc\u00edny proti Pseudomonas aeruginosa, doposia\u013e v\u0161ak bez v\u00e4\u010d\u0161\u00edch \u00faspechov [1].<\/p>\n

Zatia\u013e v\u0161ak antibiotik\u00e1 zohr\u00e1vaj\u00fa v klinickej praxi z\u00e1sadn\u00fd v\u00fdznam a s\u00fa potrebn\u00e9 opatrenia na pred\u013a\u017eenie ich pou\u017eite\u013enosti, teda zabr\u00e1neniu rozsiahlej multirezistencie. K\u013e\u00fa\u010dom k dosiahnutiu tohto cie\u013ea m\u00e1 by\u0165 racion\u00e1lne vyu\u017e\u00edvanie antibiot\u00edk a zn\u00ed\u017eenie ich spotreby (okrem vyu\u017eitia v medic\u00edne sa v zna\u010dnom rozsahu antibiotik\u00e1 kontroverzne pou\u017e\u00edvaj\u00fa aj v po\u013enohospod\u00e1rstve). Tieto z\u00e1sady racion\u00e1lneho pou\u017e\u00edvania boli p\u00edsomne formulovan\u00e9 ako odpor\u00fa\u010dania, d\u00f4le\u017eit\u00e9 organiz\u00e1cie v tomto smere s\u00fa Infectious Diseases Society of America<\/a> (IDSA) a European Society of Clinical Microbiology and Infectios Diseases<\/a> (ESCMID).Tieto odpor\u00fa\u010dania zah\u0155\u0148aj\u00fa napr\u00edklad indik\u00e1ciu antibiot\u00edk na z\u00e1klade laborat\u00f3rneho vy\u0161etrenia citlivosti, zamedzenie nadspotreby antibiot\u00edk (napr. v r\u00e1mci nemocnice viaza\u0165 pou\u017eitie niektor\u00fdch antibiot\u00edk na s\u00fahlas terapeutickej komisie), vzdel\u00e1vanie lek\u00e1rov o problematike rezistencie, pravideln\u00e9 zhodnotenia spotreby a citlivosti a \u010fal\u0161ie.<\/p>\n

Tieto odpor\u00fa\u010dania za\u010dali by\u0165 prij\u00edman\u00e9 vo vyspel\u00fdch krajin\u00e1ch v 90-tych rokoch. Aj v\u010faka tomu do\u0161lo vo Ve\u013ekej Brit\u00e1nii v rokoch 1995 \u2013 2000 k historicky prv\u00e9mu v\u00fdznamn\u00e9mu zn\u00ed\u017eeniu spotreby antibiot\u00edk, pribli\u017ene o 22 %. Od tohto obdobia \u201cre\u0161trikcie\u201d je v krajin\u00e1ch, ktor\u00e9 opatrenia zaviedli rast rezistencie miernej\u0161\u00ed. Niektor\u00e9 \u0161t\u00fadie v\u0161ak odhalili rizik\u00e1 zni\u017eovania antibiotickej spotreby, ako napr. Price a spol. 2004, ktor\u00e1 zistila s\u00favislos\u0165 medzi zv\u00fd\u0161enou mortalitou pri v komunite z\u00edskanom z\u00e1pale p\u013e\u00fac a zn\u00ed\u017een\u00edm pou\u017eit\u00edm antibiot\u00edk [2]. Preto st\u00e1le plat\u00ed, \u017ee komplikovan\u00fd probl\u00e9m antibiotickej rezistencie je z\u00e1sadnou hrozbou verejn\u00e9ho zdravotn\u00edctva a jej v\u00fdznam bude v najbli\u017e\u0161\u00edch rokoch iba r\u00e1s\u0165. Kam tento v\u00fdvoj m\u00f4\u017ee smerova\u0165 predostrela \u0161t\u00fadia publikovan\u00e1 v decembri 2015 [3]. T\u00e1 odhaduje, \u017ee do roku 2050 m\u00f4\u017ee rezistencia antibiot\u00edk\u00a0vies\u0165 ka\u017edoro\u010dne k 10 mili\u00f3nom \u00famrt\u00ed (v s\u00fa\u010dasnosti je to okolo 700 000) a k celkov\u00fdm ekonomick\u00fdm \u0161kod\u00e1m v rozsahu 100 mili\u00e1rd dol\u00e1rov, relat\u00edvne be\u017en\u00e9 chirurgick\u00e9 z\u00e1kroky m\u00f4\u017eu by\u0165 znovu \u017eivotu nebezpe\u010dn\u00fdmi. Najhor\u0161ie d\u00f4sledky sa o\u010dak\u00e1vaj\u00fa v chudobn\u00fdch krajin\u00e1ch \u2013 v \u00c1zii a Afrike. \u00a0D\u00f4sledky by v\u0161ak mali by\u0165 miernej\u0161ie pokia\u013e vedeck\u00fd pokrok v danej oblasti prinesie nov\u00e9, zatia\u013e nepoznan\u00e9 rie\u0161enia.<\/p>\n

V s\u00fa\u010dasnosti s\u00fa u\u017e k dispoz\u00edcii rozsiahle datasety \u00fadajov o antibiotickej rezistencii, ktor\u00fdch zdrojom s\u00fa mikrobiologick\u00e9 laborat\u00f3ri\u00e1, ktor\u00e9 sumarizovan\u00e9 v\u00fdsledky laborat\u00f3rnych vy\u0161etren\u00ed odosielaj\u00fa do centr\u00e1lnych datab\u00e1z. To umo\u017e\u0148uje lep\u0161ie vyhodnotenie, sledovanie trendov a \u00fa\u010dinnosti opatren\u00ed proti \u0161\u00edreniu rezistencie. \u00a0Pri t\u00fdchto \u0161tatistik\u00e1ch (niektor\u00e9 s\u00fa uveden\u00e9 ni\u017e\u0161ie v tomto \u010dl\u00e1nku), je potrebn\u00e9 si uvedomi\u0165 ich viacer\u00e9 obmedzenia (\u201c\u0161tatistika je presn\u00fd s\u00fa\u010det nepresn\u00fdch \u010d\u00edsel\u201c). Na to aby mohli by\u0165 \u00fadaje porovnate\u013en\u00e9 musia by\u0165 v prvom rade \u00a0\u0161tandardizovan\u00e9 \u2013 v\u0161ade by mal by\u0165 postup pri laborat\u00f3rnom vy\u0161etren\u00ed rovnak\u00fd. Aj ke\u010f posun v harmoniz\u00e1cii pravidiel je zna\u010dn\u00fd, napr\u00edklad aj hodnoty MIC, ktor\u00e9 sa pova\u017euj\u00fa za hranicu rezistencie sa medzi jednotliv\u00fdmi laborat\u00f3riami v niektor\u00fdch pr\u00edpadoch l\u00ed\u0161ili, tak\u017ee dve laborat\u00f3ria by mohli vyhodnoti\u0165 t\u00fa ist\u00fa vzorku odli\u0161ne. Aj ak by bola v\u0161ak metodika v\u0161ade rovnak\u00e1, ost\u00e1vaj\u00fa faktory ktor\u00e9 nevyhnutne maj\u00fa vplyv na \u0161tatistick\u00e9 v\u00fdsledky. Napr\u00edklad dostupnos\u0165 a v\u00e4\u010d\u0161ie vyu\u017eitie laborat\u00f3rneho testovania citlivosti v praxi znamen\u00e1, \u017ee zatia\u013e \u010do predt\u00fdm sa antibiotick\u00e1 citlivos\u0165 testovala najm\u00e4 v naj\u0165a\u017e\u0161\u00edch pr\u00edpadoch (napr\u00edklad nozokomi\u00e1lnych infekci\u00ed, kde zvykne by\u0165 rezistencia vysok\u00e1), ak je teraz zast\u00fapenie \u201cbe\u017en\u00fdch pr\u00edpadov\u201c v\u00e4\u010d\u0161ie tak relat\u00edvne (percentu\u00e1lne) klesne po\u010det vy\u0161etren\u00ed so zistenou multirezistenciou, \u010do vytvor\u00ed falo\u0161n\u00fd dojem \u017ee multirezistentn\u00e9 kme\u0148e s\u00fa na \u00fastupe. Inak povedan\u00e9, niektor\u00e9 \u201cekosyst\u00e9my\u201c bakt\u00e9rii s\u00fa sledovan\u00e9 viac ako ostatn\u00e9, t\u00fdchto \u201cekosyst\u00e9mov\u201c je ve\u013ea a ich vz\u00e1jomn\u00e9 vz\u0165ahy s\u00fa komplikovan\u00e9 a snaha op\u00edsa\u0165 ho jedn\u00fdch \u010d\u00edslom (percentom rezistencie) je do istej miery u\u017eito\u010dn\u00e9, ale nevyhnutne tie\u017e zjednodu\u0161uj\u00face, nevystihuj\u00face komplexnos\u0165 probl\u00e9mu.<\/p>\n

Rezistencia u bakt\u00e9rii s v\u00fdznamom pri cystickej fibr\u00f3ze<\/h4>\n

Antibiotik\u00e1 patria pri CF medzi najpou\u017e\u00edvanej\u0161ie lie\u010div\u00e1 a chronick\u00e9 infekcie sa vyskytuj\u00fa prakticky u v\u0161etk\u00fdch CF pacientov. Preto je problematika antibiotickej rezistencie pre CF ve\u013emi d\u00f4le\u017eit\u00e1, v\u00fdvoj v tejto oblasti z\u00e1sadne ovplyvn\u00ed aj celkov\u00fa progn\u00f3zu CF lie\u010dby. Inak povedan\u00e9 v pr\u00edpade r\u00fdchleho \u0161\u00edrenia multirezistencie hroz\u00ed, \u017ee niektor\u00e9 pokroky v lie\u010dbe bud\u00fa zvr\u00e1ten\u00e9.
\nPri CF sa vyskytuj\u00fa najm\u00e4 infekcie bakt\u00e9riami: Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, Burkholderia cepacia, Achromobacter xylosoxidans. Prv\u00e9 tri menovan\u00e9 maj\u00fa v\u0161eobecne v klinickej mikrobiol\u00f3gii zna\u010dn\u00fd v\u00fdznam (t.j. aj pri in\u00fdch ochoreniach ako CF) a z toho d\u00f4vodu je ich rezistencia sledovan\u00e1 a je k dispoz\u00edcii dostatok \u00fadajov. Oproti tomu B. cepacia a A. xylosoxidans s\u00fa v\u00fdznamn\u00fdmi patog\u00e9nmi iba pri CF a aj v CF popul\u00e1cii je ich v\u00fdskyt obmedzen\u00fd, preto je po\u010det kultiv\u00e1cii resp. \u00fadajov o rezistencii celkovo n\u00edzky. Klinicky najv\u00e4\u010d\u0161\u00ed v\u00fdznam pri CF maj\u00fa infekcie P. aeruginosa a B. cepacia, zatia\u013e \u010do infekcie P. aeruginosa s\u00fa u CF pacientov be\u017en\u00e9, infekcia B. cepacia je pomerne zriedkav\u00e1, ale viac nebezpe\u010dn\u00e1. Pri CF lie\u010dbe je kladen\u00fd d\u00f4raz na prevent\u00edvne opatrenia \u2013 zabr\u00e1nenie t\u00fdchto infekcii a za t\u00fdmto \u00fa\u010delom boli vypracovan\u00e9 \u0161pecifick\u00e9 medic\u00ednske odpor\u00fa\u010dania [4, 5].<\/p>\n

Staphylococcus aureus (SA)<\/h5>\n

Je ve\u013emi roz\u0161\u00edren\u00e1 bakt\u00e9ria, ktor\u00e1 be\u017ene vyvol\u00e1va r\u00f4zne infek\u010dn\u00e9 ochorenia, pri\u010dom pri CF m\u00e1 najv\u00e4\u010d\u0161\u00ed v\u00fdznam infekcia p\u013e\u00fac. Chronick\u00e9 infekcie SA, ktor\u00e9 s\u00fa pri CF pomerne \u010dast\u00e9, preuk\u00e1zate\u013ene zhor\u0161uj\u00fa priebeh a progn\u00f3zu ochorenia, napriek tomu, \u017ee iba ve\u013emi zriedkavo vyvol\u00e1va z\u00e1va\u017enej\u0161ie ak\u00fatne komplik\u00e1cie. Mimoriadne nebezpe\u010dn\u00fdm kme\u0148om je Meticil\u00edn rezistentn\u00fd SA (MRSA) ktor\u00fd je rezistentn\u00fd vo\u010di penicil\u00ednom a cefolospor\u00ednom. \u010casto sa \u0161\u00edri ako nemocni\u010dn\u00e1 (nozokomi\u00e1lna) n\u00e1kaza. Slovensko patr\u00ed medz\u00ed EU krajiny s najvy\u0161\u0161\u00edm v\u00fdskytom MRSA.<\/p>\n

V\u00fdskyt MRSA, ECDC Antimicrobial resistance surveillance in Europe 2013 [6]:<\/p>\n

\"MRSA_EU\"<\/a><\/p>\n

Pseudomonas aeruginosa (PA)<\/h5>\n

Je v pr\u00edrode be\u017ene roz\u0161\u00edren\u00e1 bakt\u00e9ria, ktor\u00e1 sp\u00f4sobuje u CF pacientov pomerne z\u00e1va\u017en\u00e9 chronick\u00e9 p\u013e\u00facne infekcie. Infikovan\u00e1 je v\u00e4\u010d\u0161ina CF pacientov. Vo v\u0161eobecnosti plat\u00ed, \u017ee nemocni\u010dn\u00e9 (nozokomi\u00e1lne) PA n\u00e1kazy (ktor\u00e9 s\u00fa mimochodom pomerne \u010dast\u00e9) s\u00fa nebezpe\u010dnej\u0161ie ako infekcie z ostatn\u00e9ho prostredia, preto\u017ee pr\u00e1ve kmene roz\u0161\u00edren\u00e9 v nemocniciach zvykn\u00fa ma\u0165 najvy\u0161\u0161iu mieru rezistencie. Aj v s\u00favislosti so segreg\u00e1ciou \u2013 zamedzen\u00ed vz\u00e1jomn\u00e9ho kontaktu pacientov ako opatrenia proti prenosu infekcie, pochopite\u013ene plat\u00ed, \u017ee aj pacient ktor\u00fd u\u017e m\u00e1 PA infekciu sa m\u00f4\u017ee infikova\u0165 \u010fal\u0161\u00edm PA kme\u0148om, ktor\u00fd ak je rezistentnej\u0161\u00ed bude pre\u0148ho nebezpe\u010dnej\u0161\u00ed. Ak sa PA infekciu nepodar\u00ed hne\u010f na za\u010diatku eliminova\u0165, tak sa st\u00e1va chronickou a vedie k r\u00fdchlej\u0161iemu a trval\u00e9mu zhor\u0161ovaniu zdravotn\u00e9ho stavu. Mo\u017enosti lie\u010dby PA s\u00fa dos\u0165 obmedzen\u00e9, ke\u010f\u017ee bakt\u00e9ria je odoln\u00e1 proti mno\u017estvu antibiot\u00edk a aj u t\u00fdch vo\u010di ktor\u00fdm bola citliv\u00e1 sa r\u00fdchlo \u0161\u00edri rezistencia. Aj v tomto pr\u00edpade je \u017eia\u013e situ\u00e1cia v SR nepriazniv\u00e1, ke\u010f\u017ee miera rezistencie je v porovnan\u00ed s ostatn\u00fdmi eur\u00f3pskymi krajinami ve\u013emi vysok\u00e1. V pr\u00edpade napr\u00edklad fluorochinol\u00f3nov najhor\u0161ia z celej Eur\u00f3py.<\/p>\n

Rezistencia Pseudomonas aeruginosa vo\u010di vybran\u00fdm antibiotik\u00e1m, v\u0161etky diagn\u00f3zy (fluorochinol\u00f3ny – napr. ciprofloxac\u00edn, aminoglykozidy \u2013 napr. tobramyc\u00edn, karbapenemy \u2013 napr. imipenem), ECDC Antimicrobial resistance surveillance in Europe 2013 [6]:<\/p>\n

\"PAPA – fluoroquinolones<\/span><\/a><\/div>
\"PAPA – ceftazidime<\/span><\/a><\/div>
\"PAPA – carbapenems<\/span><\/a><\/div>
\"PAPA – aminoglycosides<\/span><\/a><\/div><\/div>
<\/span><\/span><\/div>
<\/div><\/div><\/div>\n

V tabu\u013ek\u00e1ch ni\u017e\u0161ie s\u00fa \u00fadaje PA rezistencie v SR (z datab\u00e1zy SNARS \u00daradu verejn\u00e9ho zdravotn\u00edctva), pri\u010dom z t\u00fdchto \u00fadajov je zrejm\u00e9, \u017ee PA rezistencia m\u00e1 celkovo klesaj\u00faci trend. To plat\u00ed tak pre \u0161tatistiku v\u0161etk\u00fdch vy\u0161etren\u00ed ako aj pre v\u00fdsledky odfiltrovan\u00e9 pre CF (dg. E84). Klesaj\u00face miera PA rezistencie nie je v r\u00e1mci Eur\u00f3py typick\u00e1, ale podobn\u00fd v\u00fdvoj je aj v niektor\u00fdch \u010fal\u0161\u00edch krajin\u00e1ch (napr. vo Franc\u00fazsku a v \u010ceskej republike, vo\u010di v\u00e4\u010d\u0161ine antibiot\u00edk kles\u00e1 PA rezistencia aj vo Ve\u013ekej Brit\u00e1nii, Gr\u00e9cku). Ako bolo uveden\u00e9 vy\u0161\u0161ie, na t\u00fdchto v\u00fdsledkoch sa do istej miery m\u00f4\u017eu podie\u013ea\u0165 aj niektor\u00e9 \u0161tatistick\u00e9 skreslenia. Aj ke\u010f trend poklesu rezistencie je samozrejme pote\u0161ite\u013en\u00fd, st\u00e1le plat\u00ed, \u017ee situ\u00e1cia je aj tak v porovnan\u00ed s ostatn\u00fdmi krajinami Eur\u00f3py nepriazniv\u00e1.<\/p>\n

Trend v\u00fdvoja antibiotickej rezistencie Pseudomonas aeruginosa v SR (v %, v\u0161etky diagn\u00f3zy) [7]:<\/p>\n

\"pa_graf1\"<\/a><\/p>\n

Tento v\u00fdvoj je kop\u00edrovan\u00fd aj v pr\u00edpade CF pacientov, \u0161tatisticky sa celkov\u00e1 rezistencia zni\u017euje. Je vhodn\u00e9 poznamena\u0165 \u017ee pacient, ktor\u00fd u\u017e m\u00e1 rezistentn\u00fa formu PA infekcie nem\u00f4\u017ee realisticky o\u010dak\u00e1va\u0165, \u017ee t\u00e1 bude vylie\u010den\u00e1 (bez oh\u013eadu na to, \u010di je \u0161tatistika rezistencie klesaj\u00faca). Posun v celkovej, \u0161tatisticky vyk\u00e1zanej rezistencii m\u00f4\u017ee by\u0165 iba d\u00f4sledkom napr. diagnostikovania nov\u00fdch pacientov, ktor\u00fd s\u00fa infikovan\u00fd menej rezistentn\u00fdmi PA kme\u0148mi, resp. \u00famrt\u00edm star\u0161\u00edch pacientov, ktor\u00ed naopak maj\u00fa multirezistentn\u00e9 infekcie. \u0160pecifick\u00fdm faktorom pri CF, ktor\u00fd by \u010diasto\u010dne mohol vysvet\u013eova\u0165 tento pokles m\u00f4\u017ee by\u0165 \u00fa\u010dinok spom\u00ednan\u00fdch opatren\u00ed na zamedzenie \u0161\u00edrenie infekci\u00ed. Tieto opatrenia sa za\u010dali zav\u00e1dza\u0165 pred nie\u010do viac ako 10 rokmi, ale ich predpokladan\u00fd efekt je dlhodob\u00fd, je ho mo\u017en\u00e9 pozorova\u0165 a\u017e po v\u00e4\u010d\u0161om \u010dasovom odstupe, aspo\u0148 tak to nazna\u010duj\u00fa niektor\u00e9 zahrani\u010dn\u00e9 \u0161t\u00fadie, ktor\u00e9 sk\u00famali do akej miery s\u00fa v praxi tieto opatrenia \u00fa\u010dinn\u00e9. Vo v\u0161eobecnosti, bez oh\u013eadu na \u0161tatistiku je poh\u013ead lek\u00e1rov tak\u00fd, \u017ee situ\u00e1cia s rezistenciou sa pri CF neust\u00e1le zhor\u0161uje.<\/p>\n

Trend v\u00fdvoja antibiotickej rezistencie Pseudomonas aeruginosa v SR (v %, iba laborat\u00f3rne vy\u0161etrenia pri diagn\u00f3ze E84 – CF) [7]:<\/p>\n

\"pa_CFgraf2\"<\/a><\/p>\n

 <\/p>\n[1] Vaccines for preventing infection with Pseudomonas aeruginosa in cystic fibrosis<\/a><\/p>\n[2] Price D.B., Honeybourne D., Little P., Mayon-White R.T., Read R.C. a spol.; Community- acquired pneumonia mortality: a potential link to antibiotic prescribing trends in general practice; Respiratory Medicine 2004; 98; 17-24<\/p>\n[3] Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations<\/p>\n[4] http:\/\/www.cysticfibrosis.org.uk\/media\/82064\/pseudomonas-aeruginosa-infection-nov-04.pdf<\/a><\/p>\n[5] http:\/\/www.cysticfibrosis.org.uk\/media\/82022\/burkholderia-cepacia-sept04.pdf<\/a><\/p>\n[6] Antibiotic resistance surveillance in Europe, European Centre for Disease Prevention and Control, 2013<\/a><\/p>\n[7] Slovak National Antimicrobial Resistance System<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Rezistencia antibiotík (Antimicrobial Resistance, AMR) je rozšírený jav, pri ktorom antibiotiká prestávajú byť účinné (citlivé) na liečbu pôvodcov infekčných ochorení, baktérie nadobúdajú voči antibiotikám odolnosť. Rezistencia síce nie je žiadna nová skutočnosť, ale jej význam z viacerých dôvodov narastá. Jednak sa … Continued<\/a><\/p>\n","protected":false},"author":7,"featured_media":1785,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"kt_blocks_editor_width":"","footnotes":""},"categories":[3],"tags":[],"class_list":["post-1786","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lieky-a-liecba"],"yoast_head":"\nRezistencia antibiot\u00edk a cystick\u00e1 fibr\u00f3za - Slan\u00e9 deti<\/title>\n<meta name=\"description\" content=\"Rezistencia antibiot\u00edk je roz\u0161\u00edren\u00fd jav, pri ktorom antibiotik\u00e1 prest\u00e1vaj\u00fa by\u0165 \u00fa\u010dinn\u00e9 a bakt\u00e9rie nadob\u00fadaj\u00fa vo\u010di antibiotik\u00e1m odolnos\u0165.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/slanedeti.sk\/cms\/rezistencia-antibiotik-a-cysticka-fibroza\/1786\" \/>\n<meta property=\"og:locale\" content=\"sk_SK\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rezistencia antibiot\u00edk a cystick\u00e1 fibr\u00f3za - 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