{"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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/","title":{"rendered":"Chronick\u00e1 bronchit\u00edda - 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\/sk\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Was_steckt_dahinter\" >\u010co sa za t\u00fdm skr\u00fdva?<\/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\/sk\/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\/sk\/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\/sk\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Pro_contra_E_faecalis\" >Pro &amp; contra 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\/sk\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#%E2%80%A6_contra\" >... kontra<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Der_Mechanismus_im_Detail\" >Podrobn\u00fd mechanizmus<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Die_Selektion_durch_Antibiotika\" >V\u00fdber prostredn\u00edctvom antibiot\u00edk<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#VRE_Vancomycin-Resistant_Enterococci\" >VRE (enterokoky rezistentn\u00e9 vo\u010di vankomyc\u00ednu)<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#%E2%80%A6_und_warum_wird_Symbioflor%C2%AE_dann_verkauft\" >\u2026 a pre\u010do sa potom Symbioflor\u00ae pred\u00e1va?<\/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\/sk\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Welche_Warnzeichen_gibt_es\" >Ak\u00e9 s\u00fa varovn\u00e9 sign\u00e1ly?<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Harnwegsinfektionen_UTI\" >Infekcie mo\u010dov\u00fdch ciest (IMC).<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Intraabdominelle_Infektionen_PeritonitisAbszesse\" >Vn\u00fatrobru\u0161n\u00e9 infekcie (peritonit\u00edda\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Endokarditis\" >Endokardit\u00edda<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Sepsis_%E2%80%93_Notfall-Szenarien\" >Sepsa \u2013 n\u00fadzov\u00e9 scen\u00e1re!<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Gibt_es_keine_Alternativen\" >Neexistuj\u00fa \u017eiadne alternat\u00edvy?<\/a><\/li><\/ul><\/nav><\/div>\n<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">\u010cas \u010d\u00edtania<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">z\u00e1pisnice<\/span><\/span>\n<p class=\"wp-block-paragraph\">Symbioflor, ktor\u00fd sa okrem in\u00e9ho pou\u017e\u00edva na lie\u010dbu chronickej bronchit\u00eddy, je k dispoz\u00edcii v troch variantoch. V z\u00e1sade je na trhu u\u017e viac ako 70 rokov a obsahuje - v \u201eimunitnom\u201c variante <em>Enterococcus faecalis DSM 16440<\/em>- a <em>E.coli DSM 17252<\/em>-bakt\u00e9rie a zinok.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ka\u017ed\u00e9ho, kto trp\u00ed alergiou na pe\u013e tr\u00e1v a chronickou bronchit\u00eddou, tr\u00e1pi trval\u00fd, nelie\u010dite\u013en\u00fd hrudn\u00fd ka\u0161e\u013e, len \u010do sa v zimn\u00fdch mesiacoch \u201epohne\u201c. Len vonku, v chlade, je pokoj a ticho.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">N\u00e1v\u0161tevy u lek\u00e1ra, dokonca aj u \u00fadajne renomovan\u00fdch p\u013e\u00facnych \u0161pecialistov (pneumol\u00f3gov), neved\u00fa k n\u00e1vrhu terapie, dokonca ani k cie\u013eovo orientovanej diagn\u00f3ze, preto\u017ee diagnosticky s\u00fa v\u0161etky parametre v norme - v\u0161etko je v \u00faplnom poriadku - okrem st\u00e1le nezmenen\u00e9ho a skuto\u010dne su\u017euj\u00faceho dr\u00e1\u017ediv\u00e9ho ka\u0161\u013ea, pr\u00edpadne a\u017e zvracania.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Skuto\u010dnos\u0165, \u017ee Symbioflor p\u00f4sob\u00ed proti tomuto dr\u00e1\u017ediv\u00e9mu ka\u0161\u013eu, nie je sp\u00f4soben\u00e1 t\u00fdm. <em>E. faecalis<\/em> Hlavn\u00fdm d\u00f4vodom je jeho pozit\u00edvny, posil\u0148uj\u00faci vplyv na imunitn\u00fd syst\u00e9m v \u010dreve (GALT - Gut-Associated Lymphoid Tissue), podobne ako pri antibiotik\u00e1ch.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Av\u0161ak <em>E. faecalis<\/em> M\u00e1 vlastnosti, ktor\u00e9 m\u00f4\u017eu by\u0165 dobr\u00e9 aj zl\u00e9, v z\u00e1vislosti od stavu \u010drevn\u00e9ho imunitn\u00e9ho syst\u00e9mu. Je to r\u00fdchlo sa meniaci umelec, ktor\u00fd sa s imunitn\u00fdm syst\u00e9mom hr\u00e1 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>Doktor Jekyll<\/strong>, spo\u013eahliv\u00fd lek\u00e1r <em>E. faecalis<\/em> v \u010dreve.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Od prv\u00e9ho d\u0148a, doslova od narodenia, odv\u00e1dza pr\u00edkladn\u00fa pr\u00e1cu: produkuje vitam\u00edny, reguluje hodnotu pH, odh\u00e1\u0148a nepr\u00edjemn\u00e9 bakt\u00e9rie. Zjavne \u010destn\u00fd mu\u017e.<br>Svoje virulentn\u00e9 faktory v\u0161ak skr\u00fdva tak, ako slu\u0161n\u00e1 u\u010dite\u013esk\u00e1 kaviare\u0148 skr\u00fdva svoju \u0161\u00e1lku k\u00e1vy. Nesie spr\u00e1vne antig\u00e9ny a oklame imunitn\u00fd syst\u00e9m, aby ho ignoroval.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ale potom sa stane nie\u010do, \u010do sa v tomto pr\u00edbehu zdalo nemyslite\u013en\u00e9: antibiotikum, zranenie, porucha imunity a n\u00e1\u0161 dobr\u00fd \u010drevn\u00fd priate\u013e sa zrazu zmen\u00ed na zl\u00e9ho p\u00e1na Hyda.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A p\u00e1n Hyde m\u00e1 pl\u00e1ny. Zl\u00e9 pl\u00e1ny. Op\u00fa\u0161\u0165a bezpe\u010die \u010driev a bez pozvania putuje priamo do krvn\u00e9ho obehu.<br>Tam si vybuduje \u201ebiofilmov\u00fa\u201c pevnos\u0165, ktor\u00e1 antibiotik\u00e1m sp\u00f4sobuje krvav\u00fd nos a \u0161kr\u00edpanie zubami. Skr\u00fdva sa v makrof\u00e1goch ako \u0161kriatok v lese a klame imunitn\u00fd syst\u00e9m prote\u00ednmi, ktor\u00e9 vyzeraj\u00fa ako vstupenky na VIP p\u00e1rty.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Endokardit\u00edda? Majstrovsk\u00e9 dielo. Infekcie mo\u010dov\u00fdch ciest? Rutinn\u00e1 z\u00e1le\u017eitos\u0165. Peritone\u00e1lne infekcie? Hobby. V nemocniciach je teraz p\u00e1n Hyde hviezdnou atrakciou: sp\u00f4sobuje 11% v\u0161etk\u00fdch nozokomi\u00e1lnych infekci\u00ed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hranica medzi Jekyllom a Hydeom je nehmotn\u00e1. P\u00e1n Hyde je v\u017edy v tele doktora Jekylla. \u0160irokospektr\u00e1lne antibiotikum, imunitn\u00fd syst\u00e9m, ktor\u00fd sa \u00faplne nevylie\u010dil, a doktor Jekyll vypije nespr\u00e1vny elix\u00edr a premen\u00ed sa. Plastickos\u0165 tejto bakt\u00e9rie nem\u00e1 obdoby: unesie ak\u00fdko\u013evek g\u00e9n rezistencie vo\u010di antibiotik\u00e1m r\u00fdchlos\u0165ou vreckov\u00e9ho zlodeja.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neexistuje \u017eiadny liek, \u017eiadne s\u00e9rum, ktor\u00e9 by dok\u00e1zalo zvr\u00e1ti\u0165 transform\u00e1ciu. M\u00f4\u017eeme len d\u00fafa\u0165, \u017ee doktor Jekyll zostane v zdravom \u010dreve a nezmutuje na p\u00e1na Hyda...<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_steckt_dahinter\"><\/span>\u010co sa za t\u00fdm skr\u00fdva?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Ako <em>Agnieszka Daca<\/em> a <em>Tomasz Jarzembowski<\/em>&nbsp;vo svojom \u010dl\u00e1nku z 2024 febru\u00e1ra 19 v <em>Medzin\u00e1rodn\u00fd \u010dasopis molekul\u00e1rnych vied<\/em> \u201e<a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10888668\/\" target=\"_blank\" rel=\"noreferrer noopener\">Od priate\u013ea k nepriate\u013eovi -&nbsp;<em>Enterococcus faecalis<\/em>&nbsp;Rozmanit\u00fd vplyv na imunitn\u00fd syst\u00e9m \u010dloveka<\/a>\u201c, je <em>E. faecalis<\/em> dvojse\u010dn\u00fd me\u010d.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">EFSA (<em>Eur\u00f3psky \u00farad pre bezpe\u010dnos\u0165 potrav\u00edn<\/em>), ktor\u00fd je podobn\u00fd zoznamu GRAS (V\u0161eobecne uzn\u00e1van\u00e9 ako bezpe\u010dn\u00e9) \u00faradu FDA, obsahuje zoznam pr\u00eddavn\u00fdch l\u00e1tok v potravin\u00e1ch, materi\u00e1lov prich\u00e1dzaj\u00facich do styku s potravinami, mikroorganizmov a in\u00fdch l\u00e1tok, ktor\u00fdch bezpe\u010dnos\u0165 bola vedecky vyhodnoten\u00e1 a schv\u00e1len\u00e1.<\/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\u00e9mom je, \u017ee nie je zn\u00e1me d\u00e1vkovanie, pri ktorom sa dosiahne po\u017eadovan\u00fd \u00fa\u010dinok, ani to, v akom bode <em>E. faecalis<\/em> \u201eje \u201cpr\u00edli\u0161 ve\u013ea\" a v d\u00f4sledku toho existuje riziko translok\u00e1cie, <em>Enterococcus faecalis<\/em> prech\u00e1dza cez \u010drevn\u00fa stenu a dost\u00e1va sa do oddelen\u00ed, ako je krvn\u00fd obeh alebo peritone\u00e1lna dutina, kde sa rozv\u00edja jeho patog\u00e9nny \u00fa\u010dinok.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u010ci to vyzer\u00e1 dobre alebo zle, z\u00e1vis\u00ed od kontextu:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>V zdravom \u010dreve<\/strong> hrdina<strong>, po nadmernej konzum\u00e1cii antibiot\u00edk<\/strong> oportunista,<strong> v rane alebo na srdci<\/strong> zabijak a <strong>V nemocni\u010dnom prostred\u00ed<\/strong> s\u00e9riov\u00fd vrah.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">V uvedenom \u010dl\u00e1nku sa okrem in\u00e9ho opisuje pr\u00edpad <strong>Dysbi\u00f3za<\/strong> (ke\u010f sa mikrobi\u00f3m dostane z rovnov\u00e1hy):<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">K\u013e\u00fa\u010dov\u00fdm prvkom, ktor\u00fd <em>E. faecalis<\/em> kontrolovan\u00e9 v zdravom stave je <em>Deoxychol\u00e1t<\/em> (DCA). DCA senzibilizuje <em>E. faecalis<\/em> a riadi jeho replika\u010dn\u00fa a transkrip\u010dn\u00fa aktivitu.<br>To znamen\u00e1: <strong>Aj pri rovnakom mno\u017estve <em>E. faecalis<\/em>, ke\u010f zanikne regul\u00e1cia deoxychol\u00e1tu<\/strong> (napr. po antibiotik\u00e1ch)<strong>, jeho \u00fa\u010dinok je negat\u00edvny.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Str\u00e1nka <strong>Absol\u00fatne \u010d\u00edslo<\/strong> je menej d\u00f4le\u017eit\u00fd ako <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>Upokojuj\u00face<\/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 &amp; contra 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 vitam\u00edny, metabolizuje \u017eiviny a udr\u017eiava hodnotu pH v \u010dreve<\/strong>. To je nevyhnutn\u00e9.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Imunitn\u00fd syst\u00e9m ho potrebuje ako tr\u00e9ning<\/strong><br>MALT (lymfoidn\u00e9 tkanivo spojen\u00e9 s hlienom) dosahuje svoju pln\u00fa funk\u010dn\u00fa a \u0161truktur\u00e1lnu kapacitu a\u017e pri kontakte s komenz\u00e1lnymi bakt\u00e9riami. E. faecalis je prim\u00e1rnym \u201etr\u00e9nerom\u201c.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Chr\u00e1ni pred inv\u00e1ziou<\/strong><br>E. faecalis a in\u00e9 komenz\u00e1lne mikroorganizmy br\u00e1nia patog\u00e9nnym bakt\u00e9ri\u00e1m t\u00fdm, \u017ee s\u00fa\u0165a\u017eia o priestor a \u017eiviny a produkuj\u00fa bakterioc\u00edny.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lie\u010di z\u00e1paly<\/strong><br>Pr\u00edklad Symbioflor ukazuje, \u017ee miera recid\u00edvy chronickej bronchit\u00eddy sa po\u010das suplement\u00e1cie zn\u00ed\u017eila o 43% a 8 mesiacov po nej o 68%.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"%E2%80%A6_contra\"><\/span>... kontra<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Je to skryt\u00fd zabijak<\/strong><br>E. faecalis m\u00f4\u017ee sp\u00f4sobi\u0165 endokardit\u00eddu, urogenit\u00e1lne infekcie, intraperitone\u00e1lne infekcie a septik\u00e9miu. Pribli\u017ene 10-20% komunitn\u00fdch endokardit\u00edd sp\u00f4sobuje E. faecalis.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Je to v\u0161ade v nemocnici<\/strong><br>E. faecalis je zodpovedn\u00e1 za najmenej 11% v\u0161etk\u00fdch nozokomi\u00e1lnych infekci\u00ed (HAI - Hospital-Acquired Infection), t. j. infekci\u00ed z\u00edskan\u00fdch v nemocnici, s rast\u00facou morbiditou a mortalitou.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lie\u010dba je ne\u00famerne n\u00e1ro\u010dn\u00e1<\/strong><br><em>E. faecalis<\/em> m\u00e1 schopnos\u0165 vytv\u00e1ra\u0165 biofilmy, \u0161trukt\u00fary z polysacharidov, prote\u00ednov a lipidov, ktor\u00e9 s\u00fa prakticky nepriepustn\u00e9 pre antibiotik\u00e1 a imunitn\u00e9 bunky.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Skr\u00fdva sa pred imunitn\u00fdm syst\u00e9mom lep\u0161ie ako ak\u00fdko\u013evek \u0161pi\u00f3n<\/strong><br>V \u010dl\u00e1nku sa uv\u00e1dza: produkuje ROS, aby pre\u017eil, ukr\u00fdva sa v makrof\u00e1goch, pou\u017e\u00edva Tax (enterokokov\u00fa agrega\u010dn\u00fa l\u00e1tku) na aktiv\u00e1ciu T-buniek a t\u00fdm ich op\u00e4\u0165 oklame.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Ale nie <em>E. faecalis<\/em> je samotn\u00fd probl\u00e9m, ale \u010dasto (napr. pred oper\u00e1ciami) aj \u0161irokospektr\u00e1lne antibiotik\u00e1, ktor\u00e9 oslabuj\u00fa imunitn\u00fd syst\u00e9m.<br>Patog\u00e9nne vlastnosti sa z\u00edskavaj\u00fa horizont\u00e1lnym prenosom genetick\u00fdch prvkov s\u00favisiacich s patogenitou a rezistenciou vo\u010di antibiotik\u00e1m. Je to porovnate\u013en\u00e9 s t\u00fdm, ke\u010f si banditi nevyr\u00e1baj\u00fa zbrane sami, ale po\u017ei\u010diavaj\u00fa si cel\u00fd arzen\u00e1l od in\u00fdch.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Der_Mechanismus_im_Detail\"><\/span>Podrobn\u00fd mechanizmus<span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>1. plazmidy - dopravn\u00fd prostriedok<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Predpoklad\u00e1 sa, \u017ee plazmidov\u00e9 g\u00e9ny v enterokokoch prispeli k vzniku enterokokov rezistentn\u00fdch vo\u010di vankomyc\u00ednu (VRE), ktor\u00e9 s\u00fa obzvl\u00e1\u0161\u0165 d\u00f4le\u017eit\u00e9 v lek\u00e1rskom prostred\u00ed, ako s\u00fa kliniky, ordin\u00e1cie lek\u00e1rov at\u010f.).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Plazmidy s\u00fa<\/strong> mal\u00e9 kruhov\u00e9 k\u00fasky DNA, ktor\u00e9 sa m\u00f4\u017eu pren\u00e1\u0161a\u0165 medzi bakt\u00e9riami alebo ako USB k\u013e\u00fa\u010de, na ktor\u00fdch je ulo\u017een\u00e1 \u201eodolnos\u0165 vo\u010di antibiotik\u00e1m\u201c. <em>E. faecalis<\/em> vezme USB k\u013e\u00fa\u010d a skop\u00edruje na\u0148 g\u00e9ny.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>2. horizont\u00e1lny prenos g\u00e9nov - akt\u00edvna pred\u00e1cia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nie je to len pas\u00edvne, E. faecalis m\u00f4\u017ee by\u0165 aj akt\u00edvny:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>preberaj\u00fa plazmidy z in\u00fdch bakt\u00e9ri\u00ed (<strong>Transform\u00e1cia<\/strong>)<\/li>\n\n\n\n<li>Absorbova\u0165 fragmenty DNA z m\u0155tvych bakt\u00e9ri\u00ed<\/li>\n\n\n\n<li>Priamy kontakt s in\u00fdmi bakt\u00e9riami a v\u00fdmena g\u00e9nov (<strong>Konjug\u00e1cia<\/strong>)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">... je ako kr\u00e1de\u017e g\u00e9nov v \u010drev\u00e1ch.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Die_Selektion_durch_Antibiotika\"><\/span>V\u00fdber prostredn\u00edctvom antibiot\u00edk<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Toto je <strong>prirodzen\u00fd v\u00fdber<\/strong> v r\u00fdchlom slede za sebou:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Scen\u00e1r bez antibiot\u00edk:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>V \u010drev\u00e1ch sa vyskytuje 100 r\u00f4znych kme\u0148ov E. faecalis<\/li>\n\n\n\n<li>99 je citliv\u00fdch, 1 je n\u00e1hodne odoln\u00fd<\/li>\n\n\n\n<li>Rezistentn\u00fd kme\u0148 nem\u00e1 \u017eiadnu v\u00fdhodu (\u017eiadne antibiotikum na mieste)<\/li>\n\n\n\n<li>V\u0161etk\u00fdch 100 pre\u017eije rovnako dobre<\/li>\n\n\n\n<li>Rezistentn\u00fd kme\u0148 zost\u00e1va na \u00farovni 1%<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Scen\u00e1r s antibiotikami:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Existuje 100 r\u00f4znych kme\u0148ov E. faecalis<\/li>\n\n\n\n<li>99 je citliv\u00fdch, 1 odoln\u00fd<\/li>\n\n\n\n<li>Podaj\u00fa sa antibiotik\u00e1 a 99 \u013eud\u00ed okam\u017eite zomrie<\/li>\n\n\n\n<li>Rezistentn\u00fd kme\u0148 ovl\u00e1dne cel\u00fa stranu...<\/li>\n\n\n\n<li>Po podan\u00ed antibiot\u00edk je 95% popul\u00e1cie rezistentn\u00fdch<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">... a \u017ee za nieko\u013eko dn\u00ed stat rokov<strong>: v\u00fdberov\u00e1 expl\u00f3zia<\/strong>!<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"VRE_Vancomycin-Resistant_Enterococci\"><\/span>VRE (enterokoky rezistentn\u00e9 vo\u010di vankomyc\u00ednu)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ako pr\u00edklad z uveden\u00e9ho \u010dl\u00e1nku:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vankomyc\u00edn-rezistentn\u00e9 enterokoky (VRE) s\u00fa \u010diasto\u010dne sp\u00f4soben\u00e9 g\u00e9nmi sprostredkovan\u00fdmi plazmidmi.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pre\u010do je to de facto hororov\u00fd scen\u00e1r?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Preto\u017ee <em>Vankomyc\u00edn<\/em> . <strong>Antibiotikum poslednej in\u0161tancie<\/strong> predstavuje. Ak je patog\u00e9n rezistentn\u00fd vo\u010di v\u0161etk\u00fdm ostatn\u00fdm antibiotik\u00e1m, jedin\u00fdmi zost\u00e1vaj\u00facimi klinick\u00fdmi mo\u017enos\u0165ami s\u00fa <em>Vankomyc\u00edn<\/em>. Ak je v\u0161ak samotn\u00fd patog\u00e9n vo\u010di nemu rezistentn\u00fd, ide o probl\u00e9m, ktor\u00fd sa ned\u00e1 vyrie\u0161i\u0165 konven\u010dnou medic\u00ednou...<br>Jedinou \u00fa\u010dinnou mo\u017enos\u0165ou je pou\u017eitie \u00e9terick\u00fdch olejov, ktor\u00e9 maj\u00fa bakteric\u00eddny a viruc\u00eddny \u00fa\u010dinok a vo\u010di ktor\u00fdm sa \u017eiadny patog\u00e9n nem\u00f4\u017ee sta\u0165 rezistentn\u00fdm, preto\u017ee predstavuj\u00fa stovky r\u00f4znych \u201eantibiot\u00edk\u201c, ktor\u00fdm je patog\u00e9n vystaven\u00fd. Tak\u017ee aj <em>E. faecalis<\/em> zru\u0161i\u0165 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 pre\u010do je Symbioflor<sup>\u00ae<\/sup> potom predan\u00e9?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Je dostato\u010dne platn\u00fd na to, aby bol \u201evysk\u00fa\u0161an\u00fd a overen\u00fd\u201c, ale nie je dostato\u010dne transparentn\u00fd na to, aby bol pova\u017eovan\u00fd za modern\u00fd.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Alebo preto, \u017ee je to \u201ebezpe\u010dn\u00fd\u201c kme\u0148 a - funguje. Ako dlho, to sa e\u0161te uvid\u00ed. Napr\u00edklad kme\u0148 EF-2001 (probiotick\u00fd kme\u0148) obsahuje relat\u00edvne m\u00e1lo g\u00e9nov rezistencie vo\u010di antibiotik\u00e1m - ale tie, ktor\u00e9 m\u00e1, s\u00fa spojen\u00e9 s prirodzenou rezistenciou enterokokov vo\u010di niektor\u00fdm antibiotik\u00e1m.<\/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 ako lie\u010divo u\u017e desa\u0165ro\u010dia ve\u013emi dobre presk\u00faman\u00fd a jeho g\u00e9ny boli \u00faplne sekvenovan\u00e9.<\/strong>&#8220; Verwandte Klone sind hingegen sequenziert und hinterlegt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Po\u017eiadal som v\u00fdrobcu o kompletn\u00fa sekvenciu gen\u00f3mu <strong>Enterococcus faecalis DSM 16440<\/strong> po\u017eiadal. Pod\u013ea toho budem aktualizova\u0165.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1: <strong>Dokonca aj \u201ebezpe\u010dn\u00e9\u201c probiotick\u00e9 kmene m\u00f4\u017eu prenies\u0165 svoje prirodzen\u00e9 g\u00e9ny rezistencie na divok\u00e9 E. faecalis v \u010dreve.<\/strong> <strong>odovzda\u0165 \u010falej<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pr\u00e1ve preto sa v \u010dl\u00e1nku uv\u00e1dza, \u017ee E. faecalis sa pova\u017euje za jeden z najroz\u0161\u00edrenej\u0161\u00edch multirezistentn\u00fdch nemocni\u010dn\u00fdch patog\u00e9nov na svete.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1, \u017ee u\u017e existuj\u00fa kmene, ktor\u00e9 boli<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ampicil\u00edn<\/li>\n\n\n\n<li>Erytromyc\u00edn<\/li>\n\n\n\n<li>Fluorochinol\u00f3ny<\/li>\n\n\n\n<li>Gentamyc\u00edn<\/li>\n\n\n\n<li>Vankomyc\u00edn<\/li>\n\n\n\n<li>pr\u00edpadne nieko\u013eko z nich dohromady<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">s\u00fa odoln\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>E. faecalis<\/em> m\u00e1 <strong>pr\u00edrodn\u00e9<\/strong> Odolnos\u0165 vo\u010di:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Trimetoprim<\/li>\n\n\n\n<li>Linkosamidy (napr. klindamyc\u00edn)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">To znamen\u00e1. <strong>vn\u00fatorn\u00e1<\/strong>, nez\u00edskan\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(Viac inform\u00e1ci\u00ed o stave v\u00fdskumu v roku 2010 n\u00e1jdete na str\u00e1nke <a href=\"https:\/\/www.clinicalmicrobiologyandinfection.org\/article\/S1198-743X(14)61686-4\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">tu<\/a> k dispoz\u00edcii v plnom znen\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>(Nadmern\u00e1) spotreba antibiot\u00edk<\/strong> sp\u00f4sobuje dysbi\u00f3zu<\/li>\n\n\n\n<li><strong>Poruchy \u010drevnej bari\u00e9ry<\/strong>, napr. v d\u00f4sledku \u010drevnej oper\u00e1cie, z\u00e1palov\u00fdch ochoren\u00ed \u010driev (IBD, Crohnova choroba) a opatren\u00ed intenz\u00edvnej starostlivosti (napr. \u017eal\u00fado\u010dn\u00e1 sonda, kat\u00e9ter).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Ak je \u010drevo \u201epo\u0161koden\u00e9\u201c a <em>E. faecalis<\/em> sa nach\u00e1dza v \u010dreve, zvy\u0161uje sa riziko translok\u00e1cie.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Welche_Warnzeichen_gibt_es\"><\/span>Ak\u00e9 s\u00fa varovn\u00e9 sign\u00e1ly?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Ke\u010f sa na sc\u00e9ne objav\u00ed p\u00e1n Hyde, zvy\u010dajne sa to deje najm\u00e4 prostredn\u00edctvom<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Harnwegsinfektionen_UTI\"><\/span><strong>Infekcie mo\u010dov\u00fdch ciest (UTI)<\/strong>.<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">UTI prostredn\u00edctvom <em>E. faecalis<\/em> s\u00fa naj\u010dastej\u0161ie ak\u00fatne a diagn\u00f3za je jednoduch\u00e1 v\u010faka r\u00fdchlemu n\u00e1stupu \u0161pecifick\u00fdch pr\u00edznakov:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pocit p\u00e1lenia pri mo\u010den\u00ed<\/li>\n\n\n\n<li>\u010castej\u0161ie mo\u010denie (polakiz\u00faria)<\/li>\n\n\n\n<li>Zakalen\u00fd a\/alebo krvav\u00fd mo\u010d<\/li>\n\n\n\n<li>Boles\u0165 v podbru\u0161ku a\/alebo v panvovej oblasti<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pozor<\/strong>S <strong>imunokompromitovan\u00ed pacienti<\/strong> (napr. po transplant\u00e1cii) s\u00fa pr\u00edznaky ove\u013ea jemnej\u0161ie alebo sa v\u00f4bec nevyskytuj\u00fa. <em>tlmen\u00e1 imunitn\u00e1 odpove\u010f<\/em> spojen\u00e9 s pomerne ne\u0161pecifick\u00fdmi (alebo dokonca ch\u00fdbaj\u00facimi) pr\u00edznakmi.<br>Tu <strong>potrebuje osobitn\u00fa pozornos\u0165!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Intraabdominelle_Infektionen_PeritonitisAbszesse\"><\/span>Vn\u00fatrobru\u0161n\u00e9 infekcie (peritonit\u00edda\/abscesy)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ke\u010f sa patog\u00e9n dostane do bru\u0161nej dutiny. Pribli\u017ene 25% infekci\u00ed na jednotk\u00e1ch intenz\u00edvnej starostlivosti (JIS) je sp\u00f4soben\u00fdch <em>E. faecalis<\/em> sp\u00f4soben\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 pr\u00edznaky:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Siln\u00e1 boles\u0165 brucha<\/strong><\/li>\n\n\n\n<li><strong>Fieber &#8211; oft hoch &gt;38,5\u00b0C<\/strong><\/li>\n\n\n\n<li><strong>Nevo\u013enos\u0165 \/ vracanie<\/strong><\/li>\n\n\n\n<li><strong>Pr\u00edznaky peritonit\u00eddy<\/strong> (klasick\u00e9: str\u00e1\u017eenie - svaly sa nap\u00ednaj\u00fa okam\u017eite pri tlaku na brucho, odrazov\u00e1 citlivos\u0165 - extr\u00e9mna boles\u0165 pri n\u00e1hlom uvo\u013enen\u00ed tlaku)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Probl\u00e9m:<\/strong> Tieto pr\u00edznaky nie s\u00fa vo v\u0161eobecnosti \u0161pecifick\u00e9 pre <em>E. faecalis<\/em>, ale pr\u00e1ve bola<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>bru\u0161n\u00e1 oper\u00e1cia<\/li>\n\n\n\n<li>Transplant\u00e1cia pe\u010dene<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">a n\u00e1sledne rozv\u00edja\u0165<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hor\u00fa\u010dka<\/li>\n\n\n\n<li>Boles\u0165 brucha<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">to je zn\u00e1me ako <strong>\u010cERVEN\u00c1 VLO\u017dKA pre E. faecalis<\/strong> interpretova\u0165<strong>!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Endokarditis\"><\/span>Endokardit\u00edda<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">pri postihnut\u00ed srdcov\u00e9ho svalu. Predpoklad\u00e1 sa, \u017ee <em>E. faecalis<\/em> je v s\u00fa\u010dasnosti zodpovedn\u00e1 za 10-20% pr\u00edpadov endokardit\u00eddy z\u00edskan\u00fdch mimo nemocni\u010dn\u00e9ho prostredia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 pr\u00edznaky (klasick\u00e9):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pretrv\u00e1vaj\u00faca hor\u00fa\u010dka<\/strong> (dni\/t\u00fd\u017edne)<\/li>\n\n\n\n<li><strong>Z\u00e1vraty, slabos\u0165, \u00fanava<\/strong><\/li>\n\n\n\n<li>Nov\u00e9 alebo zhor\u0161uj\u00face sa <strong>patologick\u00fd<\/strong> <strong>\u0160elest na srdci<\/strong><\/li>\n\n\n\n<li><strong>Petechiae<\/strong> (mal\u00e9 \u010derven\u00e9 bodky na ko\u017ei - krv\u00e1canie)<\/li>\n\n\n\n<li><strong>Uzol Osler<\/strong> (bolestiv\u00e9 uzl\u00edky na kon\u010dekoch prstov)<\/li>\n\n\n\n<li><strong>Janewayove l\u00e9zie<\/strong> (indolentn\u00e9 \u010derven\u00e9 \u0161kvrny na dlaniach\/chodidl\u00e1ch)<\/li>\n\n\n\n<li><strong>Krv\u00e1canie z \u010drep\u00edn<\/strong> (mal\u00e9 krv\u00e1cania pod nechtami)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Endokardit\u00edda sp\u00f4soben\u00e1 <em>E. faecalis<\/em> m\u00f4\u017ee <strong>tich\u00fd<\/strong> t. j. nevyskytuje sa \u017eiadny z uveden\u00fdch pr\u00edznakov.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Sepsis_%E2%80%93_Notfall-Szenarien\"><\/span>Sepsa - <strong>N\u00fadzov\u00e9 scen\u00e1re!<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">v pr\u00edpade syst\u00e9mov\u00e9ho napadnutia patog\u00e9nom, t. j. ke\u010f je postihnut\u00fd cel\u00fd organizmus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Praktick\u00e9 pr\u00edznaky (<\/strong>Krit\u00e9ri\u00e1 SIRS - <em>Syndr\u00f3m syst\u00e9movej z\u00e1palovej reakcie<\/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> (biele krvinky)<strong> &gt;12.000 <\/strong>alebo<strong> &lt;4.000<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pre septick\u00fd \u0161ok<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pokles krvn\u00e9ho tlaku (ned\u00e1 sa upravi\u0165 tekutinami)<\/strong><\/li>\n\n\n\n<li><strong>Zlyhanie org\u00e1nov (obli\u010diek, pe\u010dene, p\u013e\u00fac)<\/strong><\/li>\n\n\n\n<li><strong>Zmena vedomia<\/strong><\/li>\n\n\n\n<li><strong>Tachykardia, potenie<\/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\u00fa \u017eiadne alternat\u00edvy?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Jain - aj ke\u010f je okolo v\u00fdskumn\u00fd t\u00edm <em>Mar\u00eda C. Urdaci, Laboratoire de Microbiologie et Biochimie Appliqu\u00e9e (LBMA), Universit\u00e9 de Bordeaux, Franc\u00fazsko<\/em>, ktor\u00e1 sa zaober\u00e1 <em>E. durans EP1<\/em> sa zaober\u00e1:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kme\u0148 E. durans EP1 sp\u013a\u0148a po\u017eiadavky stanoven\u00e9 EFSA. Kme\u0148 E. durans EP1 vykazoval protiz\u00e1palov\u00e9 vlastnosti, po 7 d\u0148och zv\u00fd\u0161il po\u010det IgA buniek v mezenterick\u00fdch lymfatick\u00fdch uzlin\u00e1ch a moduloval mikrobi\u00f3m zv\u00fd\u0161en\u00edm po\u010dtu Faecalibacterium prausnitzii. Okrem toho sa u my\u0161\u00ed, ktor\u00e9 dost\u00e1vali EP1 po\u010das 21 dn\u00ed, nepozorovali \u017eiadne ne\u017eiaduce \u00fa\u010dinky ako v tejto porovn\u00e1vacej \u0161t\u00fadii <em><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17466591\/\" target=\"_blank\" rel=\"noreferrer noopener\">Porovn\u00e1vacia genomick\u00e1 anal\u00fdza pr\u00edtomnosti potenci\u00e1lnych enterokokov\u00fdch faktorov virulencie v probiotickom kmeni Enterococcus faecalis Symbioflor 1<\/a><\/em> obsaden\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. duran OSY-EGY nem\u00e1 \u017eiadne plazmidy, ktor\u00e9 by mohli obsahova\u0165 \u201ezl\u00fd\u201c k\u00f3d ako tr\u00f3jsky k\u00f4\u0148 (pozri USB k\u013e\u00fa\u010d vy\u0161\u0161ie), ani ich nem\u00f4\u017ee ukr\u00fdva\u0165 a jeho gen\u00f3m obsahuje jednu potvrden\u00fa a tri potenci\u00e1lne CRISPR matice, ktor\u00e9 poskytuj\u00fa sekven\u010dn\u00fa imunitu vo\u010di modifik\u00e1cii f\u00e1gmi a horizont\u00e1lnemu prenosu g\u00e9nov.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Napriek v\u0161etk\u00fdm preuk\u00e1zan\u00fdm v\u00fdhod\u00e1m, najm\u00e4 v oblasti bezpe\u010dnosti, nie je k dispoz\u00edcii \u017eiadny komer\u010dn\u00fd 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\">\u010cas \u010d\u00edtania<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">z\u00e1pisnice<\/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\/sk\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/\" rel=\"bookmark\">\u010c\u00edta\u0165 viac \"<span class=\"screen-reader-text\">Chronick\u00e1 bronchit\u00edda - 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\/sk\/wp-json\/wp\/v2\/posts\/13123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/comments?post=13123"}],"version-history":[{"count":3,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/posts\/13123\/revisions"}],"predecessor-version":[{"id":13408,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/posts\/13123\/revisions\/13408"}],"wp:attachment":[{"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/media?parent=13123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/categories?post=13123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csiag.eu\/sk\/wp-json\/wp\/v2\/tags?post=13123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}