{"id":13123,"date":"2026-03-18T19:41:21","date_gmt":"2026-03-18T19:41:21","guid":{"rendered":"https:\/\/csiag.eu\/?p=13123"},"modified":"2026-04-10T10:47:51","modified_gmt":"2026-04-10T10:47:51","slug":"chronicka-bronchitida-symbioflor","status":"publish","type":"post","link":"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/","title":{"rendered":"Chronick\u00e1 bronchitida - Symbioflor\u00ae"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_87_1 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Obsah<\/p>\n<span class=\"ez-toc-title-toggle\"><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Jekyll_Hyde\" >Jekyll &amp; Hyde<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Was_steckt_dahinter\" >Co se za t\u00edm skr\u00fdv\u00e1?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Genomische_Besonderheiten_von_DSM_16440\" >Genomische Besonderheiten von DSM 16440<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Was_die_Sequenzierung_zeigt\" >Was die Sequenzierung zeigt<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Eine_bemerkenswerte_Unstimmigkeit\" >Eine bemerkenswerte Unstimmigkeit<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Pro_contra_E_faecalis\" >Pro a proti E. faecalis<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Pro_%E2%80%A6\" >Pro ...<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#%E2%80%A6_contra\" >... proti<\/a><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Der_Mechanismus_im_Detail\" >Podrobn\u00fd popis mechanismu<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Die_Selektion_durch_Antibiotika\" >Selekce prost\u0159ednictv\u00edm antibiotik<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#VRE_Vancomycin-Resistant_Enterococci\" >VRE (vankomycin-rezistentn\u00ed enterokoky)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#%E2%80%A6_und_warum_wird_Symbioflor%C2%AE_dann_verkauft\" >... a pro\u010d se Symbioflor\u00ae prod\u00e1v\u00e1?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Risikofaktoren\" >Rizikov\u00e9 faktory<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Welche_Warnzeichen_gibt_es\" >Jak\u00e1 jsou varovn\u00e1 znamen\u00ed?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Harnwegsinfektionen_UTI\" >Infekce mo\u010dov\u00fdch cest (UTI).<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Intraabdominelle_Infektionen_PeritonitisAbszesse\" >nitrob\u0159i\u0161n\u00ed infekce (peritonitida\/abscesy)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Endokarditis\" >Endokarditida<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Sepsis_%E2%80%93_Notfall-Szenarien\" >Sepse - nouzov\u00e9 sc\u00e9n\u00e1\u0159e!<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Gibt_es_keine_Alternativen\" >Neexistuj\u00ed \u017e\u00e1dn\u00e9 alternativy?<\/a><\/li><\/ul><\/nav><\/div>\n<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Doba \u010dten\u00ed<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">minuty<\/span><\/span>\n<p class=\"wp-block-paragraph\">Symbioflor, kter\u00fd se pou\u017e\u00edv\u00e1 mimo jin\u00e9 k l\u00e9\u010db\u011b chronick\u00e9 bronchitidy, je k dispozici ve t\u0159ech variant\u00e1ch. V z\u00e1sad\u011b je na trhu ji\u017e v\u00edce ne\u017e 70 let a obsahuje - v \u201eimunitn\u00ed\u201c variant\u011b <em>Enterococcus faecalis DSM 16440<\/em>- a <em>E.coli DSM 17252<\/em>-bakterie a zinek.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ka\u017ed\u00e9ho, kdo trp\u00ed alergi\u00ed na pyly trav a chronickou bronchitidou, tr\u00e1p\u00ed trval\u00fd, nel\u00e9\u010diteln\u00fd hrudn\u00ed ka\u0161el, jakmile se v zimn\u00edch m\u011bs\u00edc\u00edch \u201epohne\u201c. Pouze venku, v chladu, je klid a ticho.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">N\u00e1v\u0161t\u011bvy u l\u00e9ka\u0159e, dokonce i u \u00fadajn\u011b renomovan\u00fdch plicn\u00edch specialist\u016f (pneumolog\u016f), nevedou k n\u00e1vrhu terapie, dokonce ani k c\u00edlen\u011b zam\u011b\u0159en\u00e9 diagn\u00f3ze, proto\u017ee diagnosticky jsou v\u0161echny parametry v norm\u011b - v\u0161e je v naprost\u00e9m po\u0159\u00e1dku - krom\u011b st\u00e1le nem\u011bnn\u00e9ho a skute\u010dn\u011b su\u017euj\u00edc\u00edho dr\u00e1\u017ediv\u00e9ho ka\u0161le, p\u0159\u00edpadn\u011b a\u017e zvracen\u00ed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Skute\u010dnost, \u017ee Symbioflor je \u00fa\u010dinn\u00fd proti tomuto dr\u00e1\u017ediv\u00e9mu ka\u0161li, nen\u00ed zp\u016fsobena t\u00edm. <em>E. faecalis<\/em> Hlavn\u00edm d\u016fvodem je jeho pozitivn\u00ed, posiluj\u00edc\u00ed vliv na imunitn\u00ed syst\u00e9m ve st\u0159ev\u011b (GALT - Gut-Associated Lymphoid Tissue), podobn\u011b jako u antibiotik.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nicm\u00e9n\u011b <em>E. faecalis<\/em> M\u00e1 vlastnosti, kter\u00e9 mohou b\u00fdt dobr\u00e9 i \u201e\u0161patn\u00e9\u201c, v z\u00e1vislosti na stavu st\u0159evn\u00edho imunitn\u00edho syst\u00e9mu. Je to rychlokva\u0161ka, kter\u00e1 si s imunitn\u00edm syst\u00e9mem hraje na mimikry.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Jekyll_Hyde\"><\/span>Jekyll &amp; Hyde<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Dr. Jekyll<\/strong>, spolehliv\u00fd l\u00e9ka\u0159 <em>E. faecalis<\/em> ve st\u0159ev\u011b.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Od prvn\u00edho dne, doslova od narozen\u00ed, odv\u00e1d\u00ed p\u0159\u00edkladnou pr\u00e1ci: produkuje vitam\u00edny, reguluje hodnotu pH, zah\u00e1n\u00ed nep\u0159\u00edjemn\u00e9 bakterie. Zjevn\u011b \u010destn\u00fd mu\u017e.<br>Sv\u00e9 virulentn\u00ed faktory v\u0161ak skr\u00fdv\u00e1 jako slu\u0161n\u00e1 u\u010ditelsk\u00e1 kav\u00e1rna sv\u016fj \u0161\u00e1lek k\u00e1vy. Nese spr\u00e1vn\u00e9 antigeny a obelst\u00ed imunitn\u00ed syst\u00e9m, aby ho ignoroval.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pak se ale stane n\u011bco, co se v tomto p\u0159\u00edb\u011bhu zd\u00e1lo nemysliteln\u00e9: antibiotika, zran\u011bn\u00ed, porucha imunity a n\u00e1\u0161 dobr\u00fd st\u0159evn\u00ed p\u0159\u00edtel se najednou zm\u011bn\u00ed ve zl\u00e9ho pana Hyda.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A pan Hyde m\u00e1 sv\u00e9 pl\u00e1ny. Zl\u00e9 pl\u00e1ny. Opou\u0161t\u00ed bezpe\u010d\u00ed st\u0159ev a bez pozv\u00e1n\u00ed putuje p\u0159\u00edmo do krevn\u00edho ob\u011bhu.<br>Tam si vybuduje \u201ebiofilmovou\u201c pevnost, kter\u00e1 antibiotik\u016fm zp\u016fsobuje krv\u00e1cen\u00ed z nosu a sk\u0159\u00edp\u00e1n\u00ed zub\u016f. Skr\u00fdv\u00e1 se v makrof\u00e1z\u00edch jako sk\u0159et v lese a klame imunitn\u00ed syst\u00e9m proteiny, kter\u00e9 vypadaj\u00ed jako vstupenky na VIP ve\u010d\u00edrek.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Endokarditida? Mistrovsk\u00e9 d\u00edlo. Infekce mo\u010dov\u00fdch cest? Rutinn\u00ed. Infekce pob\u0159i\u0161nice? Kon\u00ed\u010dek. V nemocnic\u00edch je nyn\u00ed pan Hyde hv\u011bzdnou atrakc\u00ed: zp\u016fsobuje 11% v\u0161ech nozokomi\u00e1ln\u00edch infekc\u00ed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hranice mezi Jekyllem a Hydem je nehmotn\u00e1. Pan Hyde je v\u017edy v t\u011ble doktora Jekylla. \u0160irokospektr\u00e1ln\u00ed antibiotikum, imunitn\u00ed syst\u00e9m, kter\u00fd se zcela nevyl\u00e9\u010dil, a doktor Jekyll vypije \u0161patn\u00fd elix\u00edr a prom\u011bn\u00ed se. Plasticita t\u00e9to bakterie nem\u00e1 obdoby: rychlost\u00ed kapesn\u00edho zlod\u011bje unese jak\u00fdkoli gen rezistence v\u016f\u010di antibiotik\u016fm.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neexistuje \u017e\u00e1dn\u00fd l\u00e9k, \u017e\u00e1dn\u00e9 s\u00e9rum, kter\u00e9 by dok\u00e1zalo zvr\u00e1tit prom\u011bnu. Lze jen doufat, \u017ee doktor Jekyll z\u016fstane ve zdrav\u00e9m st\u0159ev\u011b a nezmutuje v pana Hyda...<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_steckt_dahinter\"><\/span>Co se za t\u00edm skr\u00fdv\u00e1?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Jak <em>Agnieszka Daca<\/em> a <em>Tomasz Jarzembowski<\/em>&nbsp;ve sv\u00e9m \u010dl\u00e1nku z 19. \u00fanora 2024 v \u010dasopise <em>Mezin\u00e1rodn\u00ed \u010dasopis molekul\u00e1rn\u00edch v\u011bd<\/em> \u201e<a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10888668\/\" target=\"_blank\" rel=\"noreferrer noopener\">Od p\u0159\u00edtele k nep\u0159\u00edteli -&nbsp;<em>Enterococcus faecalis<\/em>&nbsp;Rozmanit\u00fd vliv na lidsk\u00fd imunitn\u00ed syst\u00e9m<\/a>\u201c, je <em>E. faecalis<\/em> dvojse\u010dn\u00e1 zbra\u0148.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00da\u0159ad EFSA (<em>Evropsk\u00fd \u00fa\u0159ad pro bezpe\u010dnost potravin<\/em>), podobn\u011b jako seznam GRAS (Generally Recognised as Safe - obecn\u011b uzn\u00e1van\u00fd jako bezpe\u010dn\u00fd) FDA, obsahuje seznam potravin\u00e1\u0159sk\u00fdch p\u0159\u00eddatn\u00fdch l\u00e1tek, materi\u00e1l\u016f p\u0159ich\u00e1zej\u00edc\u00edch do styku s potravinami, mikroorganism\u016f a dal\u0161\u00edch l\u00e1tek, jejich\u017e bezpe\u010dnost byla v\u011bdecky vyhodnocena a schv\u00e1lena.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Symbioflor<sup>\u00ae<\/sup> wurde nicht genehmigt, obwohl es den \u201esichereren&#8220; Stamm DSM 16440 enth\u00e4lt. Der Hauptgrund liegt nicht allein in der Jekyll-&amp;-Hyde-Problematik der Spezies, sondern auch darin, dass <strong>keine publizierte Genomsequenz explizit f\u00fcr DSM 16440<\/strong> vorliegt (s. Abschnitt \u201eGenomische Besonderheiten&#8220;). F\u00fcr eine EFSA-QPS-Listung (Qualified Presumption of Safety) reicht die stellvertretende Sequenzierung verwandter Klone formal nicht aus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Probl\u00e9mem je, \u017ee nen\u00ed zn\u00e1mo, p\u0159i jak\u00e9m d\u00e1vkov\u00e1n\u00ed je dosa\u017eeno po\u017eadovan\u00e9ho \u00fa\u010dinku, ani v jak\u00e9m okam\u017eiku. <em>E. faecalis<\/em> \u201eje \u201cp\u0159\u00edli\u0161 mnoho\" a hroz\u00ed translokace, <em>Enterococcus faecalis<\/em> proch\u00e1z\u00ed st\u0159evn\u00ed st\u011bnou a dost\u00e1v\u00e1 se do prost\u0159ed\u00ed, jako je krevn\u00ed \u0159e\u010di\u0161t\u011b nebo peritone\u00e1ln\u00ed dutina, kde rozv\u00edj\u00ed sv\u016fj patogenn\u00ed \u00fa\u010dinek.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Zda to vypad\u00e1 dob\u0159e, nebo \u0161patn\u011b, z\u00e1le\u017e\u00ed na kontextu:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ve zdrav\u00e9m st\u0159ev\u011b<\/strong> hrdina<strong>, po nadm\u011brn\u00e9 konzumaci antibiotik<\/strong> oportunista,<strong> v r\u00e1n\u011b nebo na srdci<\/strong> zabij\u00e1ka a <strong>V nemocni\u010dn\u00edm prost\u0159ed\u00ed<\/strong> s\u00e9riov\u00fd vrah.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">V\u00fd\u0161e zm\u00edn\u011bn\u00fd \u010dl\u00e1nek popisuje mimo jin\u00e9 p\u0159\u00edpad <strong>Dysbi\u00f3za<\/strong> (kdy\u017e se mikrobiom dostane z rovnov\u00e1hy):<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kl\u00ed\u010dov\u00fdm prvkem, kter\u00fd <em>E. faecalis<\/em> \u0159\u00edzen\u00e1 ve zdrav\u00e9m stavu je <em>Deoxychol\u00e1t<\/em> (DCA). DCA senzibilizuje <em>E. faecalis<\/em> a \u0159\u00edd\u00ed jeho replika\u010dn\u00ed a transkrip\u010dn\u00ed aktivitu.<br>To znamen\u00e1: <strong>I p\u0159i stejn\u00e9m mno\u017estv\u00ed <em>E. faecalis<\/em>, kdy\u017e deoxychol\u00e1tov\u00e1 regulace zanikne<\/strong> (nap\u0159. po antibiotik\u00e1ch)<strong>, se jeho \u00fa\u010dinek zm\u011bn\u00ed na negativn\u00ed.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Na str\u00e1nk\u00e1ch <strong>Absolutn\u00ed \u010d\u00edslo<\/strong> je m\u00e9n\u011b d\u016fle\u017eit\u00fd ne\u017e <strong>rovnov\u00e1ha syst\u00e9mu<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Genomische_Besonderheiten_von_DSM_16440\"><\/span>Genomische Besonderheiten von DSM 16440<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\"><strong>Wichtige Erg\u00e4nzung auf Basis publizierter Sequenzierungsdaten<\/strong><\/p>\n<\/blockquote>\n\n\n\n<p class=\"wp-block-paragraph\">Symbioflor\u00ae enth\u00e4lt <em>E. faecalis<\/em> DSM 16440, einen von urspr\u00fcnglich zehn Isolaten, die in den 1950er Jahren aus dem Stuhl eines gesunden Menschen gewonnen wurden. Diese zehn Isolate tragen DSM-Nummern 16430 bis 16439.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pulsfeldgelelektrophorese-Analysen ergaben, dass <strong>DSM 16440 zu einer Gruppe von acht genomisch identischen Klonen<\/strong> geh\u00f6rt (DSM 16430, 16432, 16433, 16435\u201316439). Sequenzierungen wurden an den Klonen DSM 16430, 16431 und 16434 durchgef\u00fchrt und in \u00f6ffentlichen Datenbanken hinterlegt (European Nucleotide Archive: FLUS00000000 f\u00fcr DSM 16430, FLUT00000000 f\u00fcr DSM 16434; EMBL: HF558530 f\u00fcr das vollst\u00e4ndige Genom von DSM 16431).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Eine unter dem Akzessionsnamen DSM 16440 direkt publizierte Genomsequenz existiert nicht.<\/strong> SymbioPharm referenziert auf ihrer Website Sequenzierungspublikationen zu verwandten Klonen als Nachweis. Dies stellt eine regulatorisch akzeptierte, aber nicht vollst\u00e4ndig transparente L\u00f6sung dar. Der Hersteller wurde um die vollst\u00e4ndige Genomsequenz von DSM 16440 gebeten; eine Antwort steht aus.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_die_Sequenzierung_zeigt\"><\/span>Was die Sequenzierung zeigt<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Die genomische Analyse der Symbioflor-1-Klone ist in einem wesentlichen Punkt <strong>Uklid\u0148uj\u00edc\u00ed<\/strong>:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Der Stamm hat die wichtigsten Virulenzgene <strong>verloren<\/strong>. Konkret fehlen:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Cytolysin<\/strong><br>Zellgift, das rote Blutk\u00f6rperchen und Immunzellen zerst\u00f6rt<\/li>\n\n\n\n<li><strong>Gelatinase \/ Coccolysin<\/strong>-<br>Gewebeabbauendes Enzym<\/li>\n\n\n\n<li><strong>Enterokokkales Oberfl\u00e4chenprotein (esp\/efaA)<\/strong> <br>Adh\u00e4sions- und Immunevasionsfaktor<\/li>\n\n\n\n<li><strong>Hyaluronidase<\/strong><br>Gewebs-invasives Enzym<\/li>\n\n\n\n<li><strong>Peptidantibiotikum AS-48<\/strong><\/li>\n\n\n\n<li><strong>vanB-Operon<\/strong><br>Vancomycin-Resistenz<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Noch vorhanden sind hingegen: Aggregationssubstanz, Kollagenadh\u00e4sionsprotein, Kapselbildungsgene, Resistenz gegen Sauerstoffradikale, Eigenschaften, die f\u00fcr die Schleimhautkolonisierung und damit f\u00fcr die probiotische Wirkung relevant sind.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Eine_bemerkenswerte_Unstimmigkeit\"><\/span>Eine bemerkenswerte Unstimmigkeit<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Allerdings zeigt sich bei genauem Hinsehen eine Inkonsistenz: <strong>DSM 16430<\/strong>, der als Repr\u00e4sentant der acht identischen Klone (zu denen DSM 16440 geh\u00f6rt) sequenziert wurde, besitzt ein <strong>kleineres Genom<\/strong> als die anderen Isolate. Ihm fehlt ein ~100 kb-Bereich, der unter anderem die <strong>Aggregationssubstanz<\/strong> kodiert, sowie ein ~36 kb-<strong>Prophagen<\/strong>-kodierender Bereich.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Das bedeutet: Wenn DSM 16430 als Sequenzierungsnachweis f\u00fcr DSM 16440 gilt, ist unklar, ob DSM 16440 die Aggregationssubstanz tats\u00e4chlich besitzt oder nicht, obwohl andere Publikationen sie f\u00fcr den Symbioflor-Stamm als vorhanden beschreiben (basierend auf dem vollst\u00e4ndiger sequenzierten DSM 16431). Dieser Widerspruch ist in der Literatur nicht aufgel\u00f6st.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Pro_contra_E_faecalis\"><\/span>Pro a proti E. faecalis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Pro_%E2%80%A6\"><\/span>Pro ...<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>E. faecalis<\/em> produkuje vitaminy, metabolizuje \u017eiviny a udr\u017euje hodnotu pH ve st\u0159evech.<\/strong>. To je z\u00e1sadn\u00ed.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Imunitn\u00ed syst\u00e9m ji pot\u0159ebuje jako tr\u00e9nink<\/strong><br>MALT (lymfoidn\u00ed tk\u00e1\u0148 spojen\u00e1 s hlenem) dosahuje sv\u00e9 pln\u00e9 funk\u010dn\u00ed a struktur\u00e1ln\u00ed kapacity a\u017e p\u0159i kontaktu s komenz\u00e1ln\u00edmi bakteriemi. Prim\u00e1rn\u00edm \u201etren\u00e9rem\u201c je E. faecalis.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Chr\u00e1n\u00ed p\u0159ed invaz\u00ed<\/strong><br>E. faecalis a dal\u0161\u00ed komenz\u00e1ln\u00ed mikroorganismy br\u00e1n\u00ed patogenn\u00edm bakteri\u00edm t\u00edm, \u017ee sout\u011b\u017e\u00ed o prostor a \u017eiviny a produkuj\u00ed bakteriociny.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>L\u00e9\u010d\u00ed z\u00e1n\u011bty<\/strong><br>P\u0159\u00edklad Symbioflor ukazuje, \u017ee se m\u00edra recidivy chronick\u00e9 bronchitidy sn\u00ed\u017eila o 43% b\u011bhem suplementace a o 68% 8 m\u011bs\u00edc\u016f pot\u00e9.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"%E2%80%A6_contra\"><\/span>... proti<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Je to skryt\u00fd zabij\u00e1k<\/strong><br>E. faecalis m\u016f\u017ee zp\u016fsobit endokarditidu, urogenit\u00e1ln\u00ed infekce, intraperitone\u00e1ln\u00ed infekce a sepsi. P\u0159ibli\u017en\u011b 10-20% komunitn\u00edch endokarditid je zp\u016fsobeno E. faecalis.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>V nemocnici je to v\u0161ude<\/strong><br>E. faecalis je zodpov\u011bdn\u00e1 za nejm\u00e9n\u011b 11% v\u0161ech nozokomi\u00e1ln\u00edch infekc\u00ed (HAI - Hospital-Acquired Infection), tj. infekc\u00ed z\u00edskan\u00fdch v nemocnici, s rostouc\u00ed morbiditou a mortalitou.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>L\u00e9\u010dba je ne\u00fam\u011brn\u011b obt\u00ed\u017en\u00e1.<\/strong><br><em>E. faecalis<\/em> m\u00e1 schopnost vytv\u00e1\u0159et biofilmy, struktury z polysacharid\u016f, protein\u016f a lipid\u016f, kter\u00e9 jsou prakticky neprostupn\u00e9 pro antibiotika a imunitn\u00ed bu\u0148ky.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Skr\u00fdv\u00e1 se p\u0159ed imunitn\u00edm syst\u00e9mem l\u00e9pe ne\u017e jak\u00fdkoli \u0161pi\u00f3n.<\/strong><br>Z \u010dl\u00e1nku vypl\u00fdv\u00e1: produkuje ROS, aby p\u0159e\u017eil, skr\u00fdv\u00e1 se v makrof\u00e1z\u00edch, pou\u017e\u00edv\u00e1 Tax (enterokokovou agrega\u010dn\u00ed l\u00e1tku), aby aktivoval T-bu\u0148ky a t\u00edm je op\u011bt oklamal.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Ale ne <em>E. faecalis<\/em> je probl\u00e9m s\u00e1m o sob\u011b, ale \u010dasto (nap\u0159. p\u0159ed operacemi) i \u0161irokospektr\u00e1 antibiotika, kter\u00e1 oslabuj\u00ed imunitn\u00ed syst\u00e9m.<br>Patogenn\u00ed vlastnosti se z\u00edsk\u00e1vaj\u00ed horizont\u00e1ln\u00edm p\u0159enosem genetick\u00fdch prvk\u016f spojen\u00fdch s patogenitou a rezistenc\u00ed k antibiotik\u016fm. To je srovnateln\u00e9 s t\u00edm, kdy\u017e si bandit\u00e9 nevyrob\u00ed zbran\u011b sami, ale vyp\u016fj\u010d\u00ed si cel\u00fd arzen\u00e1l od jin\u00fdch.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Der_Mechanismus_im_Detail\"><\/span>Podrobn\u00fd popis mechanismu<span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>1. plazmidy - dopravn\u00ed prost\u0159edek<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">P\u0159edpokl\u00e1d\u00e1 se, \u017ee plazmidov\u00e9 geny v enterokoc\u00edch p\u0159isp\u011bly k rozvoji enterokok\u016f rezistentn\u00edch v\u016f\u010di vankomycinu (VRE), kter\u00e9 jsou zvl\u00e1\u0161t\u011b d\u016fle\u017eit\u00e9 ve zdravotnick\u00e9m prost\u0159ed\u00ed, jako jsou kliniky, ordinace l\u00e9ka\u0159\u016f atd.).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Plazmidy jsou<\/strong> mal\u00e9 kruhov\u00e9 kousky DNA, kter\u00e9 si mohou bakterie p\u0159ed\u00e1vat mezi sebou nebo jako USB kl\u00ed\u010denky, na nich\u017e je ulo\u017eena \u201erezistence v\u016f\u010di antibiotik\u016fm\u201c. <em>E. faecalis<\/em> vezme USB disk a zkop\u00edruje na n\u011bj geny.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>2. horizont\u00e1ln\u00ed p\u0159enos gen\u016f - aktivn\u00ed predace<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nejedn\u00e1 se pouze o pasivn\u00ed infekci, E. faecalis m\u016f\u017ee b\u00fdt i aktivn\u00ed:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>p\u0159eb\u00edraj\u00ed plasmidy z jin\u00fdch bakteri\u00ed (<strong>Transformace<\/strong>)<\/li>\n\n\n\n<li>Absorbuj\u00ed fragmenty DNA z mrtv\u00fdch bakteri\u00ed<\/li>\n\n\n\n<li>P\u0159\u00edm\u00fd kontakt s jin\u00fdmi bakteriemi a v\u00fdm\u011bna gen\u016f (<strong>Konjugace<\/strong>)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">... je jako kr\u00e1de\u017e gen\u016f ve st\u0159evech.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Die_Selektion_durch_Antibiotika\"><\/span>Selekce prost\u0159ednictv\u00edm antibiotik<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Toto je <strong>p\u0159\u00edrodn\u00ed v\u00fdb\u011br<\/strong> v rychl\u00e9m sledu:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Sc\u00e9n\u00e1\u0159 bez antibiotik:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ve st\u0159evech se vyskytuje 100 r\u016fzn\u00fdch kmen\u016f E. faecalis.<\/li>\n\n\n\n<li>99 je citliv\u00fdch, 1 je n\u00e1hodn\u011b odoln\u00fd<\/li>\n\n\n\n<li>Rezistentn\u00ed kmen nem\u00e1 \u017e\u00e1dnou v\u00fdhodu (na m\u00edst\u011b nen\u00ed \u017e\u00e1dn\u00e9 antibiotikum).<\/li>\n\n\n\n<li>V\u0161ech 100 p\u0159e\u017e\u00edv\u00e1 stejn\u011b dob\u0159e<\/li>\n\n\n\n<li>Rezistentn\u00ed kmen z\u016fst\u00e1v\u00e1 na 1%<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Sc\u00e9n\u00e1\u0159 s antibiotiky:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Existuje 100 r\u016fzn\u00fdch kmen\u016f E. faecalis.<\/li>\n\n\n\n<li>99 je citliv\u00fdch, 1 odoln\u00fd<\/li>\n\n\n\n<li>Pod\u00e1vaj\u00ed se antibiotika a 99 lid\u00ed okam\u017eit\u011b um\u00edr\u00e1.<\/li>\n\n\n\n<li>Rezistentn\u00ed kmen ovl\u00e1dne celou stranu...<\/li>\n\n\n\n<li>Po pod\u00e1n\u00ed antibiotik je 95% populace rezistentn\u00edch.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">... a \u017ee za n\u011bkolik dn\u00ed stat let<strong>: v\u00fdb\u011brov\u00e1 exploze<\/strong>!<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"VRE_Vancomycin-Resistant_Enterococci\"><\/span>VRE (vankomycin-rezistentn\u00ed enterokoky)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">jako p\u0159\u00edklad z v\u00fd\u0161e uveden\u00e9ho \u010dl\u00e1nku:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vankomycin-rezistentn\u00ed enterokoky (VRE) jsou \u010d\u00e1ste\u010dn\u011b zp\u016fsobeny geny zprost\u0159edkovan\u00fdmi plazmidy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pro\u010d je to de facto hororov\u00fd sc\u00e9n\u00e1\u0159?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Proto\u017ee <em>Vankomycin<\/em> na <strong>Antibiotikum posledn\u00ed instance<\/strong> p\u0159edstavuje. Pokud je patogen rezistentn\u00ed na v\u0161echna ostatn\u00ed antibiotika, zb\u00fdvaj\u00ed jedin\u00e9 klinick\u00e9 mo\u017enosti. <em>Vankomycin<\/em>. Pokud je v\u0161ak samotn\u00fd patogen v\u016f\u010di n\u011bmu rezistentn\u00ed, jedn\u00e1 se o probl\u00e9m, kter\u00fd nelze vy\u0159e\u0161it konven\u010dn\u00ed medic\u00ednou...<br>Jedinou \u00fa\u010dinnou mo\u017enost\u00ed je pou\u017eit\u00ed \u00e9terick\u00fdch olej\u016f, kter\u00e9 maj\u00ed baktericidn\u00ed a virucidn\u00ed \u00fa\u010dinek a v\u016f\u010di nim\u017e se \u017e\u00e1dn\u00fd patogen nem\u016f\u017ee st\u00e1t rezistentn\u00edm, proto\u017ee p\u0159edstavuj\u00ed stovky r\u016fzn\u00fdch \u201eantibiotik\u201c, jim\u017e je patogen vystaven. Tak\u017ee i <em>E. faecalis<\/em> zru\u0161it plachty.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00fcr DSM 16440 gilt:<\/strong> Das vanB-Operon, der h\u00e4ufigste Resistenzweg gegen Vancomycin bei Enterokokken, fehlt dem Stamm genomisch vollst\u00e4ndig. Das ist ein wesentlicher Sicherheitsvorteil gegen\u00fcber klinischen Isolaten.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"%E2%80%A6_und_warum_wird_Symbioflor%C2%AE_dann_verkauft\"><\/span>... a pro\u010d je Symbioflor<sup>\u00ae<\/sup> pak prod\u00e1ny?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Je dostate\u010dn\u011b platn\u00fd, aby byl \u201evyzkou\u0161en\u00fd\u201c, ale nen\u00ed dostate\u010dn\u011b transparentn\u00ed, aby byl pova\u017eov\u00e1n za modern\u00ed.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nebo proto, \u017ee je to \u201ebezpe\u010dn\u00fd\u201c kmen a - funguje. Jak dlouho, to se teprve uvid\u00ed. Nap\u0159\u00edklad kmen EF-2001 (probiotick\u00fd kmen) obsahuje relativn\u011b m\u00e1lo gen\u016f rezistence v\u016f\u010di antibiotik\u016fm - ale ty, kter\u00e9 m\u00e1, jsou spojeny s p\u0159irozenou rezistenc\u00ed enterokok\u016f v\u016f\u010di n\u011bkter\u00fdm antibiotik\u016fm.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Die Sequenzierungsdaten f\u00fcr den Symbioflor 1 Stamm DSM 16440 sind nicht verf\u00fcgbar gemacht, weshalb eine \u00dcberpr\u00fcfung der exakten Zusammensetzung nicht gegeben ist, obwohl der Hersteller auf seiner Webseite verk\u00fcndet &#8222;<strong>Enterococcus faecalis DSM 16440 je jako l\u00e9\u010divo ji\u017e n\u011bkolik desetilet\u00ed velmi dob\u0159e prozkoum\u00e1n a jeho geny byly pln\u011b sekvenov\u00e1ny.<\/strong>&#8220; Verwandte Klone sind hingegen sequenziert und hinterlegt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Po\u017e\u00e1dal jsem v\u00fdrobce o kompletn\u00ed sekvenci genomu <strong>Enterococcus faecalis DSM 16440<\/strong> po\u017eadov\u00e1no. Podle toho je budu aktualizovat.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1: <strong>Dokonce i \u201ebezpe\u010dn\u00e9\u201c probiotick\u00e9 kmeny mohou p\u0159en\u00e1\u0161et sv\u00e9 p\u0159irozen\u00e9 geny rezistence na divok\u00e9 E. faecalis ve st\u0159ev\u011b.<\/strong> <strong>p\u0159edat d\u00e1l<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pr\u00e1v\u011b proto se v \u010dl\u00e1nku uv\u00e1d\u00ed, \u017ee E. faecalis je pova\u017eov\u00e1na za jeden z nejroz\u0161\u00ed\u0159en\u011bj\u0161\u00edch multirezistentn\u00edch nemocni\u010dn\u00edch patogen\u016f na sv\u011bt\u011b.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1, \u017ee ji\u017e existuj\u00ed kmeny, kter\u00e9 byly<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ampicilin<\/li>\n\n\n\n<li>Erytromycin<\/li>\n\n\n\n<li>Fluorochinolony<\/li>\n\n\n\n<li>Gentamycin<\/li>\n\n\n\n<li>Vankomycin<\/li>\n\n\n\n<li>p\u0159\u00edpadn\u011b n\u011bkolik z nich dohromady<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">jsou odoln\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>E. faecalis<\/em> m\u00e1 adresu <strong>p\u0159\u00edrodn\u00ed<\/strong> Odolnost v\u016f\u010di:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Trimetoprim<\/li>\n\n\n\n<li>Linkosamidy (nap\u0159. klindamycin)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1. <strong>vnit\u0159n\u00ed<\/strong>, nebyly z\u00edsk\u00e1ny.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(Dal\u0161\u00ed informace o stavu v\u00fdzkumu v roce 2010 naleznete na str\u00e1nce <a href=\"https:\/\/www.clinicalmicrobiologyandinfection.org\/article\/S1198-743X(14)61686-4\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">zde<\/a> k dispozici v pln\u00e9m zn\u011bn\u00ed).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Risikofaktoren\"><\/span>Rizikov\u00e9 faktory<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>(Nadm\u011brn\u00e1) spot\u0159eba antibiotik<\/strong> zp\u016fsobuje dysbi\u00f3zu<\/li>\n\n\n\n<li><strong>Poruchy st\u0159evn\u00ed bari\u00e9ry<\/strong>, nap\u0159. v d\u016fsledku st\u0159evn\u00ed operace, z\u00e1n\u011btliv\u00fdch st\u0159evn\u00edch onemocn\u011bn\u00ed (IBD, Crohnova choroba) a opat\u0159en\u00ed intenzivn\u00ed p\u00e9\u010de (nap\u0159. \u017ealude\u010dn\u00ed sonda, kat\u00e9tr).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pokud je st\u0159evo \u201epo\u0161kozeno\u201c a <em>E. faecalis<\/em> se nach\u00e1z\u00ed ve st\u0159ev\u011b, zvy\u0161uje se riziko translokace.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Welche_Warnzeichen_gibt_es\"><\/span>Jak\u00e1 jsou varovn\u00e1 znamen\u00ed?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Kdy\u017e se na sc\u00e9n\u011b objev\u00ed pan Hyde, obvykle se tak d\u011bje p\u0159edev\u0161\u00edm prost\u0159ednictv\u00edm<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Harnwegsinfektionen_UTI\"><\/span><strong>Infekce mo\u010dov\u00fdch cest (UTI)<\/strong>.<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">UTI prost\u0159ednictv\u00edm <em>E. faecalis<\/em> jsou nej\u010dast\u011bji akutn\u00ed a diagn\u00f3za je snadn\u00e1 d\u00edky rychl\u00e9mu n\u00e1stupu specifick\u00fdch p\u0159\u00edznak\u016f:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pocit p\u00e1len\u00ed p\u0159i mo\u010den\u00ed<\/li>\n\n\n\n<li>\u010cast\u011bj\u0161\u00ed mo\u010den\u00ed (polakisurie)<\/li>\n\n\n\n<li>Zakalen\u00e1 a\/nebo krvav\u00e1 mo\u010d<\/li>\n\n\n\n<li>Bolest v podb\u0159i\u0161ku a\/nebo v p\u00e1nevn\u00ed oblasti<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pozor<\/strong>S <strong>imunokompromitovan\u00ed pacienti<\/strong> (nap\u0159. po transplantaci), jsou p\u0159\u00edznaky mnohem m\u00edrn\u011bj\u0161\u00ed nebo nejsou p\u0159\u00edtomny v\u016fbec. <em>tlumen\u00e1 imunitn\u00ed reakce<\/em> spojen\u00e9 s pom\u011brn\u011b nespecifick\u00fdmi (nebo dokonce chyb\u011bj\u00edc\u00edmi) p\u0159\u00edznaky.<br>Zde <strong>pot\u0159ebuje zvl\u00e1\u0161tn\u00ed pozornost!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Intraabdominelle_Infektionen_PeritonitisAbszesse\"><\/span>nitrob\u0159i\u0161n\u00ed infekce (peritonitida\/abscesy)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">kdy\u017e se patogen dostane do b\u0159i\u0161n\u00ed dutiny. P\u0159ibli\u017en\u011b 25% infekc\u00ed na jednotk\u00e1ch intenzivn\u00ed p\u00e9\u010de (JIP) je zp\u016fsobeno <em>E. faecalis<\/em> zp\u016fsobeno.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 p\u0159\u00edznaky:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Siln\u00e1 bolest b\u0159icha<\/strong><\/li>\n\n\n\n<li><strong>Fieber &#8211; oft hoch &gt;38,5\u00b0C<\/strong><\/li>\n\n\n\n<li><strong>Nevolnost \/ zvracen\u00ed<\/strong><\/li>\n\n\n\n<li><strong>P\u0159\u00edznaky peritonitidy<\/strong> (klasick\u00fd: str\u00e1\u017en\u00fd - svaly se napnou okam\u017eit\u011b p\u0159i tlaku na b\u0159icho, odrazov\u00e1 citlivost - extr\u00e9mn\u00ed bolest p\u0159i n\u00e1hl\u00e9m uvoln\u011bn\u00ed tlaku)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Probl\u00e9m:<\/strong> Tyto p\u0159\u00edznaky nejsou obecn\u011b specifick\u00e9 pro <em>E. faecalis<\/em>, ale pr\u00e1v\u011b byla<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>b\u0159i\u0161n\u00ed operace<\/li>\n\n\n\n<li>Transplantace jater<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">a pot\u00e9 se vyvinou v<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hore\u010dka<\/li>\n\n\n\n<li>Bolest b\u0159icha<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">to je zn\u00e1m\u00e9 jako <strong>\u010cerven\u00e1 vlajka pro E. faecalis<\/strong> interpretovat<strong>!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Endokarditis\"><\/span>Endokarditida<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">p\u0159i posti\u017een\u00ed srde\u010dn\u00edho svalu. P\u0159edpokl\u00e1d\u00e1 se, \u017ee <em>E. faecalis<\/em> je nyn\u00ed zodpov\u011bdn\u00e1 za 10-20% p\u0159\u00edpad\u016f endokarditidy z\u00edskan\u00fdch mimo nemocni\u010dn\u00ed prost\u0159ed\u00ed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 p\u0159\u00edznaky (klasick\u00e9):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>P\u0159etrv\u00e1vaj\u00edc\u00ed hore\u010dka<\/strong> (dny\/t\u00fddny)<\/li>\n\n\n\n<li><strong>Z\u00e1vrat\u011b, slabost, \u00fanava<\/strong><\/li>\n\n\n\n<li>Nov\u00e9 nebo zhor\u0161uj\u00edc\u00ed se <strong>patologick\u00fd<\/strong> <strong>\u0160elest na srdci<\/strong><\/li>\n\n\n\n<li><strong>Petechiae<\/strong> (mal\u00e9 \u010derven\u00e9 te\u010dky na k\u016f\u017ei - krv\u00e1cen\u00ed)<\/li>\n\n\n\n<li><strong>Uzel Osler<\/strong> (bolestiv\u00e9 uzl\u00edky na kone\u010dc\u00edch prst\u016f)<\/li>\n\n\n\n<li><strong>Janewayovy l\u00e9ze<\/strong> (indolentn\u00ed \u010derven\u00e9 skvrny na dlan\u00edch\/plosk\u00e1ch nohou)<\/li>\n\n\n\n<li><strong>T\u0159\u00ed\u0161tiv\u00e9 krv\u00e1cen\u00ed<\/strong> (drobn\u00e9 krv\u00e1cen\u00ed pod nehty)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Endokarditida zp\u016fsoben\u00e1 <em>E. faecalis<\/em> m\u016f\u017ee <strong>tich\u00fd<\/strong> tj. \u017e\u00e1dn\u00fd z v\u00fd\u0161e uveden\u00fdch p\u0159\u00edznak\u016f se nevyskytuje.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Sepsis_%E2%80%93_Notfall-Szenarien\"><\/span>Sepse - <strong>Nouzov\u00e9 sc\u00e9n\u00e1\u0159e!<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">v p\u0159\u00edpad\u011b syst\u00e9mov\u00e9ho napaden\u00ed patogenem, tj. posti\u017een\u00ed cel\u00e9ho organismu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 p\u0159\u00edznaky (<\/strong>Krit\u00e9ria SIRS - <em>Syndrom syst\u00e9mov\u00e9 z\u00e1n\u011btliv\u00e9 odpov\u011bdi<\/em><strong>):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fieber &gt;38\u00b0C oder Hypothermie &lt;36\u00b0C<\/strong><\/li>\n\n\n\n<li><strong>Herzfrequenz &gt;90\/min<\/strong><\/li>\n\n\n\n<li><strong>Atemfrequenz &gt;20\/min oder pCO2 &lt;32 mmHg<\/strong><\/li>\n\n\n\n<li><strong>Leukocyty<\/strong> (b\u00edl\u00e9 krvinky)<strong> &gt;12.000 <\/strong>nebo<strong> &lt;4.000<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pro septick\u00fd \u0161ok<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pokles krevn\u00edho tlaku (nelze napravit tekutinami).<\/strong><\/li>\n\n\n\n<li><strong>Selh\u00e1n\u00ed org\u00e1n\u016f (ledviny, j\u00e1tra, pl\u00edce)<\/strong><\/li>\n\n\n\n<li><strong>Zm\u011bna v\u011bdom\u00ed<\/strong><\/li>\n\n\n\n<li><strong>Tachykardie, pocen\u00ed<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Gibt_es_keine_Alternativen\"><\/span>Neexistuj\u00ed \u017e\u00e1dn\u00e9 alternativy?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Jain - a\u010dkoli je kolem v\u00fdzkumn\u00fd t\u00fdm <em>Mar\u00eda C. Urdaci, Laboratoire de Microbiologie et Biochimie Appliqu\u00e9e (LBMA), Universit\u00e9 de Bordeaux, Francie<\/em>, kter\u00e1 se zab\u00fdv\u00e1 <em>E. durans EP1<\/em> se zab\u00fdv\u00e1:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kmen E. durans EP1 spl\u0148uje po\u017eadavky EFSA. Kmen E. durans EP1 vykazoval protiz\u00e1n\u011btliv\u00e9 vlastnosti, po 7 dnech zv\u00fd\u0161il po\u010det IgA bun\u011bk v mezenterick\u00fdch lymfatick\u00fdch uzlin\u00e1ch a moduloval mikrobiom zv\u00fd\u0161en\u00edm po\u010dtu Faecalibacterium prausnitzii. Krom\u011b toho nebyly u my\u0161\u00ed, kter\u00e9 dost\u00e1valy EP1 po dobu 21 dn\u016f, pozorov\u00e1ny \u017e\u00e1dn\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky, stejn\u011b jako v t\u00e9to srovn\u00e1vac\u00ed studii. <em><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17466591\/\" target=\"_blank\" rel=\"noreferrer noopener\">Srovn\u00e1vac\u00ed genomick\u00e1 anal\u00fdza p\u0159\u00edtomnosti potenci\u00e1ln\u00edch faktor\u016f enterokokov\u00e9 virulence u probiotick\u00e9ho kmene Enterococcus faecalis Symbioflor 1<\/a><\/em> obsazeno.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. duran OSY-EGY nem\u00e1 \u017e\u00e1dn\u00e9 plazmidy, kter\u00e9 by mohly obsahovat \u201e\u0161patn\u00fd\u201c k\u00f3d, jako je trojsk\u00fd k\u016f\u0148 (viz USB flash disk v\u00fd\u0161e), ani je nem\u016f\u017ee ukr\u00fdvat, a jeho genom obsahuje jedno potvrzen\u00e9 a t\u0159i potenci\u00e1ln\u00ed pole CRISPR, kter\u00e1 poskytuj\u00ed sekven\u010dn\u00ed imunitu v\u016f\u010di f\u00e1gov\u00e9 modifikaci a horizont\u00e1ln\u00edmu p\u0159enosu gen\u016f.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Navzdory v\u0161em prok\u00e1zan\u00fdm v\u00fdhod\u00e1m, zejm\u00e9na v oblasti bezpe\u010dnosti, nen\u00ed k dispozici \u017e\u00e1dn\u00fd komer\u010dn\u00ed produkt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Doba \u010dten\u00ed<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">minuty<\/span><\/span>Symbioflor, u.a. gegen chronische Bronchitis eingesetzt, wird in drei Varianten angeboten. Es ist vom Grundsatz her seit \u00fcber 70 Jahren auf dem Markt und beinhaltet &#8211; in der &#8222;immun&#8220;-Variante &#8211; Enterococcus faecalis DSM 16440&#8211; und E.coli DSM 17252-Bakterien und Zink. Wer an einer Gr\u00e4serpollen-Allergie und chronischer Bronchitis leidet, wird in den Wintermonaten von einem permanenten,&hellip;&nbsp;<a href=\"https:\/\/csiag.eu\/cs\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/\" rel=\"bookmark\">\u010c\u00edst d\u00e1le \"<span class=\"screen-reader-text\">Chronick\u00e1 bronchitida - Symbioflor\u00ae<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-13123","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"modified_by":"Achim Goerner","_links":{"self":[{"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/posts\/13123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/comments?post=13123"}],"version-history":[{"count":3,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/posts\/13123\/revisions"}],"predecessor-version":[{"id":13408,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/posts\/13123\/revisions\/13408"}],"wp:attachment":[{"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/media?parent=13123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/categories?post=13123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csiag.eu\/cs\/wp-json\/wp\/v2\/tags?post=13123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}