{"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":"kronik-bronsit-symbioflor","status":"publish","type":"post","link":"https:\/\/csiag.eu\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/","title":{"rendered":"Kronik bron\u015fit - Symbioflor\u00ae"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_83 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\">\u0130\u00e7indekiler tablosu<\/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\/tr\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Was_steckt_dahinter\" >Bunun arkas\u0131nda ne var?<\/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\/tr\/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\/tr\/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\/tr\/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\/tr\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Pro_%E2%80%A6\" >Profesyonel ...<\/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\/tr\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Der_Mechanismus_im_Detail\" >Ayr\u0131nt\u0131l\u0131 mekanizma<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Die_Selektion_durch_Antibiotika\" >Antibiyotikler arac\u0131l\u0131\u011f\u0131yla se\u00e7ilim<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#VRE_Vancomycin-Resistant_Enterococci\" >VRE (Vankomisine Diren\u00e7li Enterokoklar)<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#%E2%80%A6_und_warum_wird_Symbioflor%C2%AE_dann_verkauft\" >...ve Symbioflor\u00ae neden sat\u0131l\u0131yor?<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Risikofaktoren\" >Risk fakt\u00f6rleri<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Welche_Warnzeichen_gibt_es\" >Uyar\u0131 i\u015faretleri nelerdir?<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Harnwegsinfektionen_UTI\" >\u0130drar yolu enfeksiyonlar\u0131 (\u0130YE).<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Intraabdominelle_Infektionen_PeritonitisAbszesse\" >Kar\u0131n i\u00e7i enfeksiyonlar (peritonit\/abse)<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Endokarditis\" >Endokardit<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Sepsis_%E2%80%93_Notfall-Szenarien\" >Sepsis \u2013 Acil Durum Senaryolar\u0131!<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/#Gibt_es_keine_Alternativen\" >Alternatif yok mu?<\/a><\/li><\/ul><\/nav><\/div>\n<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Okuma s\u00fcresi<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">dakika<\/span><\/span>\n<p>Di\u011fer \u015feylerin yan\u0131 s\u0131ra kronik bron\u015fit tedavisinde kullan\u0131lan Symbioflor'un \u00fc\u00e7 \u00e7e\u015fidi mevcuttur. Prensip olarak, 70 y\u0131l\u0131 a\u015fk\u0131n bir s\u00fcredir piyasadad\u0131r ve \u201eba\u011f\u0131\u015f\u0131kl\u0131k\u201c varyant\u0131nda \u015funlar\u0131 i\u00e7erir <em>Enterococcus faecalis DSM 16440<\/em>- ve <em>E.coli DSM 17252<\/em>-Bakteri ve \u00e7inko.<\/p>\n\n\n\n<p>\u00c7im poleni alerjisi ve kronik bron\u015fiti olan herkes k\u0131\u015f aylar\u0131nda \u201ehareket eder etmez\u201c kal\u0131c\u0131, tedavi edilemez bir g\u00f6\u011f\u00fcs \u00f6ks\u00fcr\u00fc\u011f\u00fcne yakalan\u0131r. Sadece d\u0131\u015far\u0131da, so\u011fukta huzur ve sessizlik vard\u0131r.<\/p>\n\n\n\n<p>Doktor ziyaretleri, hatta g\u00f6r\u00fcn\u00fc\u015fte tan\u0131nm\u0131\u015f akci\u011fer uzmanlar\u0131na (pn\u00f6mologlar) bile, bir tedavi \u00f6nerisi, hatta hedefe y\u00f6nelik bir te\u015fhis ile sonu\u00e7lanmaz, \u00e7\u00fcnk\u00fc te\u015fhis a\u00e7\u0131s\u0131ndan t\u00fcm parametreler normaldir - her \u015fey m\u00fckemmel bir d\u00fczen i\u00e7indedir - hala de\u011fi\u015fmeyen ve ger\u00e7ekten rahats\u0131z edici \u00f6ks\u00fcr\u00fck d\u0131\u015f\u0131nda, muhtemelen kusma noktas\u0131na kadar.<\/p>\n\n\n\n<p>Symbioflor'un bu rahats\u0131z edici \u00f6ks\u00fcr\u00fc\u011fe kar\u015f\u0131 i\u015fe yaramas\u0131n\u0131n nedeni <em>E. faecalis<\/em> Bunun ana nedeni, antibiyotiklere benzer \u015fekilde ba\u011f\u0131rsaktaki ba\u011f\u0131\u015f\u0131kl\u0131k sistemi (GALT - Gut-Associated Lymphoid Tissue) \u00fczerindeki olumlu, g\u00fc\u00e7lendirici etkisidir.<\/p>\n\n\n\n<p>Ancak <em>E. faecalis<\/em> Ba\u011f\u0131rsak ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin durumuna ba\u011fl\u0131 olarak hem iyi hem de \u201ek\u00f6t\u00fc\u201c olabilen \u00f6zelliklere sahiptir. Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi ile taklit\u00e7ilik oynayan h\u0131zl\u0131 bir de\u011fi\u015fim sanat\u00e7\u0131s\u0131d\u0131r.<\/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><strong>Dr. Jekyll<\/strong>, g\u00fcvenilir doktor <em>E. faecalis<\/em> ba\u011f\u0131rsakta.<\/p>\n\n\n\n<p>\u0130lk g\u00fcnden beri, kelimenin tam anlam\u0131yla do\u011fdu\u011fundan beri, \u00f6rnek bir i\u015f yap\u0131yor: vitamin \u00fcretiyor, pH de\u011ferini d\u00fczenliyor, k\u00f6t\u00fc bakterileri koval\u0131yor. A\u00e7\u0131k\u00e7a onurlu bir adam.<br>Bununla birlikte, \u00f6ld\u00fcr\u00fcc\u00fc fakt\u00f6rlerini sayg\u0131n bir \u00f6\u011fretmen kahvesinin kahve fincan\u0131n\u0131 saklad\u0131\u011f\u0131 gibi saklar. Do\u011fru antijenleri ta\u015f\u0131r ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemini onu g\u00f6rmezden gelmesi i\u00e7in kand\u0131r\u0131r.<\/p>\n\n\n\n<p>Ama sonra bu hikayede asl\u0131nda d\u00fc\u015f\u00fcn\u00fclemez gibi g\u00f6r\u00fcnen bir \u015fey olur: bir antibiyotik, bir yaralanma, bir ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi ve aniden iyi ba\u011f\u0131rsak dostumuz k\u00f6t\u00fc Bay Hyde'a d\u00f6n\u00fc\u015f\u00fcr.<\/p>\n\n\n\n<p>Ve Bay Hyde'\u0131n planlar\u0131 var. \u015eeytani planlar. Ba\u011f\u0131rsaklar\u0131n g\u00fcvenli\u011fini terk eder ve herhangi bir davet olmaks\u0131z\u0131n do\u011frudan kan dola\u015f\u0131m\u0131na girer.<br>Orada antibiyotiklerin burunlar\u0131n\u0131 kanatan ve di\u015flerini g\u0131c\u0131rdatan bir \u201ebiyofilm\u201c kalesi in\u015fa eder. Ormandaki bir cin gibi makrofajlar\u0131n i\u00e7inde saklan\u0131r ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemini VIP parti bileti gibi g\u00f6r\u00fcnen proteinlerle aldat\u0131r.<\/p>\n\n\n\n<p>Endokardit mi? Ba\u015fyap\u0131t. \u0130drar yolu enfeksiyonu? Rutin. Periton enfeksiyonlar\u0131? Hobi. Hastanelerde, Bay Hyde art\u0131k en \u00e7ok ilgi \u00e7eken ki\u015fi: t\u00fcm hastane enfeksiyonlar\u0131n\u0131n 11%'sine neden oluyor.<\/p>\n\n\n\n<p>Jekyll ve Hyde aras\u0131ndaki s\u0131n\u0131r soyuttur. Bay Hyde her zaman Dr. Jekyll'in bedenindedir. Geni\u015f spektrumlu bir antibiyotik, tam olarak iyile\u015fmemi\u015f bir ba\u011f\u0131\u015f\u0131kl\u0131k sistemi ve Dr. Jekyll yanl\u0131\u015f iksiri i\u00e7er ve d\u00f6n\u00fc\u015f\u00fcr. Bu bakterinin esnekli\u011fi benzersizdir: herhangi bir antibiyotik diren\u00e7 genini bir yankesici h\u0131z\u0131yla ele ge\u00e7irir.<\/p>\n\n\n\n<p>D\u00f6n\u00fc\u015f\u00fcm\u00fc tersine \u00e7evirebilecek ne bir tedavi ne de bir serum vard\u0131r. Sadece Dr Jekyll'in sa\u011fl\u0131kl\u0131 bir ba\u011f\u0131rsakta kalmas\u0131 ve Bay Hyde'a d\u00f6n\u00fc\u015fmemesi umulabilir...<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_steckt_dahinter\"><\/span>Bunun arkas\u0131nda ne var?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Nas\u0131l <em>Agnieszka Daca<\/em> ve <em>Tomasz Jarzembowski<\/em>&nbsp;2024 \u015eubat 19 tarihli makalesinde <em>Uluslararas\u0131 molek\u00fcler bilimler dergisi<\/em> \u201e<a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10888668\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dosttan D\u00fc\u015fmana-&nbsp;<em>Enterococcus faecalis<\/em>&nbsp;\u0130nsan Ba\u011f\u0131\u015f\u0131kl\u0131k Sistemi \u00dczerindeki \u00c7e\u015fitli Etkiler<\/a>\u201c, oldu\u011funu <em>E. faecalis<\/em> iki ucu keskin bir k\u0131l\u0131\u00e7.<\/p>\n\n\n\n<p>EFSA (<em>Avrupa G\u0131da G\u00fcvenli\u011fi Otoritesi<\/em>), FDA'n\u0131n GRAS (Generally Recognised as Safe) listesine benzer \u015fekilde, g\u00fcvenli\u011fi bilimsel olarak de\u011ferlendirilmi\u015f ve onaylanm\u0131\u015f g\u0131da katk\u0131 maddelerini, g\u0131da ile temas eden malzemeleri, mikroorganizmalar\u0131 ve di\u011fer maddeleri listeler.<\/p>\n\n\n\n<p>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>Sorun \u015fu ki, istenen etkinin hangi dozajda elde edildi\u011fi ya da hangi noktada elde edildi\u011fi bilinmemektedir. <em>E. faecalis<\/em> \u201e\u00e7ok fazla\u201c ve yer de\u011fi\u015ftirmenin eli kula\u011f\u0131nda, <em>Enterococcus faecalis<\/em> ba\u011f\u0131rsak duvar\u0131ndan ge\u00e7erek kan dola\u015f\u0131m\u0131 veya periton bo\u015flu\u011fu gibi b\u00f6lmelere girer ve burada patojenik etkisini geli\u015ftirir.<\/p>\n\n\n\n<p>Yani iyi ya da k\u00f6t\u00fc g\u00f6r\u00fcnmesi ba\u011flama g\u00f6re de\u011fi\u015fir:<\/p>\n\n\n\n<p><strong>Sa\u011fl\u0131kl\u0131 bir ba\u011f\u0131rsakta<\/strong> bir kahraman<strong>, a\u015f\u0131r\u0131 antibiyotik t\u00fcketiminden sonra<\/strong> bir f\u0131rsat\u00e7\u0131,<strong> bir yarada ya da kalpte<\/strong> bir katil ve <strong>Hastane ortam\u0131nda<\/strong> bir seri katil.<\/p>\n\n\n\n<p>Yukar\u0131da bahsi ge\u00e7en makalede, di\u011fer hususlar\u0131n yan\u0131 s\u0131ra, bir <strong>Disbiyoz<\/strong> (mikrobiyom dengesizle\u015fti\u011finde):<\/p>\n\n\n\n<p>Anahtar bir unsur <em>E. faecalis<\/em> sa\u011fl\u0131kl\u0131 bir durumda kontroll\u00fc <em>Deoksikolat<\/em> (DCA). DCA hassasla\u015ft\u0131r\u0131r <em>E. faecalis<\/em> ve replikatif ve transkripsiyonel aktivitesini kontrol eder.<br>Bu \u015fu demek: <strong>Ayn\u0131 miktarda olsa bile <em>E. faecalis<\/em>, deoksikolat reg\u00fclasyonu ortadan kalkt\u0131\u011f\u0131nda<\/strong> (\u00f6rn. antibiyotiklerden sonra)<strong>, etkisi negatife d\u00f6ner.<\/strong><\/p>\n\n\n\n<p>Bu <strong>Mutlak say\u0131<\/strong> daha az \u00f6nemlidir <strong>sistemin dengesi<\/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><strong>Wichtige Erg\u00e4nzung auf Basis publizierter Sequenzierungsdaten<\/strong><\/p>\n<\/blockquote>\n\n\n\n<p>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>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><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>Die genomische Analyse der Symbioflor-1-Klone ist in einem wesentlichen Punkt <strong>Sakinle\u015ftirici<\/strong>:<\/p>\n\n\n\n<p>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>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>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>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>Profesyonel ...<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>E. faecalis<\/em> vitamin \u00fcretir, besinleri metabolize eder ve ba\u011f\u0131rsak pH de\u011ferini korur<\/strong>. Bu \u00e7ok \u00f6nemli.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi e\u011fitim olarak buna ihtiya\u00e7 duyar<\/strong><br>MALT (mukusla ili\u015fkili lenfoid doku) tam i\u015flevsel ve yap\u0131sal kapasitesine ancak kommensal bakterilerle temas yoluyla ula\u015f\u0131r. E. faecalis birincil \u201ee\u011fiticidir\u201c.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>\u0130stilaya kar\u015f\u0131 korur<\/strong><br>E. faecalis ve di\u011fer kommensal mikroorganizmalar, yer ve besin i\u00e7in rekabet ederek ve bakteriyosinler \u00fcreterek patojenik bakterileri \u00f6nler.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>\u0130ltihaplanmay\u0131 iyile\u015ftirir<\/strong><br>Symbioflor \u00f6rne\u011fi, kronik bron\u015fitte n\u00fcks oran\u0131n\u0131n takviye s\u0131ras\u0131nda 43% ve 8 ay sonra 68% azald\u0131\u011f\u0131n\u0131 g\u00f6stermektedir.<\/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>Bu gizli bir katil<\/strong><br>E. faecalis endokardit, \u00fcrogenital enfeksiyonlar, intraperitoneal enfeksiyonlar ve septisemiye neden olabilir. Toplum kaynakl\u0131 endokarditlerin yakla\u015f\u0131k 10-20%'sine E. faecalis neden olmaktad\u0131r.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hastanenin her yerinde var.<\/strong><br>E. faecalis, t\u00fcm hastane enfeksiyonlar\u0131n\u0131n (HAI - Hospital-Acquired Infection) en az 11%'sinden, yani artan morbidite ve mortalite ile hastane kaynakl\u0131 enfeksiyonlardan sorumludur.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Tedavi edilmesi orant\u0131s\u0131z derecede zordur<\/strong><br><em>E. faecalis<\/em> polisakkaritler, proteinler ve lipidlerden olu\u015fan, antibiyotiklere ve ba\u011f\u0131\u015f\u0131kl\u0131k h\u00fccrelerine kar\u015f\u0131 neredeyse a\u015f\u0131lmaz bir yap\u0131 olan biyofilm olu\u015fturma yetene\u011fine sahiptir.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ba\u011f\u0131\u015f\u0131kl\u0131k sisteminden herhangi bir casustan daha iyi saklan\u0131r<\/strong><br>Makale \u015funu g\u00f6steriyor: Hayatta kalmak i\u00e7in ROS \u00fcretiyor, makrofajlarda saklan\u0131yor, T h\u00fccrelerini aktive etmek i\u00e7in Tax (enterokokal agregasyon maddesi) kullan\u0131yor ve b\u00f6ylece onlar\u0131 tekrar kand\u0131r\u0131yor.<\/li>\n<\/ul>\n\n\n\n<p>Ama de\u011fil <em>E. faecalis<\/em> sorunun kendisi de\u011fil, genellikle (\u00f6rne\u011fin ameliyatlardan \u00f6nce) ba\u011f\u0131\u015f\u0131kl\u0131k sistemini zay\u0131flatan geni\u015f spektrumlu antibiyotiklerdir.<br>Patojenik \u00f6zellikler, patojenite ve antibiyotik direnci ile ili\u015fkili genetik unsurlar\u0131n yatay transferi yoluyla kazan\u0131l\u0131r. Bu durum, haydutlar\u0131n kendi silahlar\u0131n\u0131 \u00fcretmeyip ba\u015fkalar\u0131ndan t\u00fcm cephaneli\u011fi \u00f6d\u00fcn\u00e7 almalar\u0131na benzemektedir.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Der_Mechanismus_im_Detail\"><\/span>Ayr\u0131nt\u0131l\u0131 mekanizma<span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p><strong>1. plazmidler - ta\u015f\u0131ma ara\u00e7lar\u0131<\/strong><\/p>\n\n\n\n<p>Enterokoklardaki plazmid arac\u0131l\u0131 genlerin, \u00f6zellikle klinikler, doktor ameliyatlar\u0131 gibi t\u0131bbi ortamlarda \u00f6nemli olan vankomisine diren\u00e7li enterokoklar\u0131n (VRE) geli\u015fimine katk\u0131da bulundu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir.).<\/p>\n\n\n\n<p><strong>Plazmidler<\/strong> Bakteriler aras\u0131nda aktar\u0131labilen k\u00fc\u00e7\u00fck, dairesel DNA par\u00e7alar\u0131 veya \u201eantibiyotik direncinin\u201c depoland\u0131\u011f\u0131 USB bellekler gibi. <em>E. faecalis<\/em> bir USB bellek al\u0131r ve genleri ona kopyalar.<\/p>\n\n\n\n<p><strong>2. yatay gen transferi - aktif predasyon<\/strong><\/p>\n\n\n\n<p>Bu sadece pasif de\u011fildir, E. faecalis aktif de olabilir:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>di\u011fer bakterilerden plazmidleri al\u0131r (<strong>D\u00f6n\u00fc\u015f\u00fcm<\/strong>)<\/li>\n\n\n\n<li>\u00d6l\u00fc bakterilerden DNA par\u00e7alar\u0131n\u0131 emer<\/li>\n\n\n\n<li>Di\u011fer bakterilerle do\u011frudan temas kurar ve gen al\u0131\u015fveri\u015finde bulunur (<strong>Konjugasyon<\/strong>)<\/li>\n<\/ul>\n\n\n\n<p>... ba\u011f\u0131rsaklardaki gen h\u0131rs\u0131zl\u0131\u011f\u0131 gibidir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Die_Selektion_durch_Antibiotika\"><\/span>Antibiyotikler arac\u0131l\u0131\u011f\u0131yla se\u00e7ilim<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Bu bir <strong>do\u011fal se\u00e7ilim<\/strong> h\u0131zl\u0131 bir \u015fekilde art arda:<\/p>\n\n\n\n<p><strong>Antibiyotiksiz senaryo:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ba\u011f\u0131rsaklar\u0131n\u0131zda 100 farkl\u0131 E. faecalis t\u00fcr\u00fc vard\u0131r<\/li>\n\n\n\n<li>99'u hassas, 1'i rastgele diren\u00e7lidir<\/li>\n\n\n\n<li>Diren\u00e7li su\u015fun hi\u00e7bir avantaj\u0131 yoktur (sahada antibiyotik yok)<\/li>\n\n\n\n<li>100'\u00fc de e\u015fit derecede hayatta kal\u0131r<\/li>\n\n\n\n<li>Diren\u00e7li su\u015f 1%'de kal\u0131r<\/li>\n<\/ul>\n\n\n\n<p><strong>Antibiyotikli senaryo:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>E. faecalis'in 100 farkl\u0131 t\u00fcr\u00fc vard\u0131r<\/li>\n\n\n\n<li>99'u hassas, 1'i diren\u00e7li<\/li>\n\n\n\n<li>Antibiyotikler uygulan\u0131r ve 99 ki\u015fi hemen \u00f6l\u00fcr<\/li>\n\n\n\n<li>Diren\u00e7li t\u00fcr t\u00fcm partiyi ele ge\u00e7irir ...<\/li>\n\n\n\n<li>Antibiyotik uygulamas\u0131ndan sonra, pop\u00fclasyonun 95%'si diren\u00e7lidir<\/li>\n<\/ul>\n\n\n\n<p>... ve birka\u00e7 g\u00fcn i\u00e7inde stat y\u0131l<strong>: bir se\u00e7me patlamas\u0131<\/strong>!<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"VRE_Vancomycin-Resistant_Enterococci\"><\/span>VRE (Vankomisine Diren\u00e7li Enterokoklar)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Yukar\u0131daki makaleden bir \u00f6rnek olarak:<\/p>\n\n\n\n<p>Vankomisine diren\u00e7li enterokoklar (VRE) k\u0131smen plazmid arac\u0131l\u0131 genlerden kaynaklanmaktad\u0131r.<\/p>\n\n\n\n<p><strong>Bu neden fiili bir korku senaryosu?<\/strong><\/p>\n\n\n\n<p>\u00c7\u00fcnk\u00fc <em>Vankomisin<\/em> ve <strong>Son \u00e7are antibiyotik<\/strong> temsil eder. Patojen di\u011fer t\u00fcm antibiyotiklere diren\u00e7liyse, geriye kalan tek klinik se\u00e7enek \u015funlard\u0131r <em>Vankomisin<\/em>. Ancak patojenin kendisi buna diren\u00e7liyse, bu geleneksel t\u0131p taraf\u0131ndan \u00e7\u00f6z\u00fclemeyecek bir sorundur ...<br>Tek etkili se\u00e7enek, bakterisidal ve vir\u00fcsidal etkiye sahip olan ve patojenin maruz kald\u0131\u011f\u0131 y\u00fczlerce farkl\u0131 \u201eantibiyoti\u011fi\u201c temsil ettikleri i\u00e7in hi\u00e7bir patojenin diren\u00e7li hale gelemeyece\u011fi u\u00e7ucu ya\u011flar\u0131n kullan\u0131lmas\u0131d\u0131r. Yani hatta <em>E. faecalis<\/em> yelkenler.<\/p>\n\n\n\n<p><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>... ve neden Symbioflor<sup>\u00ae<\/sup> Sonra sat\u0131ld\u0131 m\u0131?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>\u201eDenenmi\u015f ve test edilmi\u015f\u201c olmak i\u00e7in yeterince ge\u00e7erli, ancak modern olarak kabul edilecek kadar \u015feffaf de\u011fil.<\/strong><\/p>\n\n\n\n<p>Ya da \u201eg\u00fcvenli\u201c bir t\u00fcr oldu\u011fu ve i\u015fe yarad\u0131\u011f\u0131 i\u00e7in. Ne kadar s\u00fcreyle i\u015fe yarayaca\u011f\u0131n\u0131 zaman g\u00f6sterecek. \u00d6rne\u011fin, EF-2001 su\u015fu (probiyotik bir su\u015f) nispeten az say\u0131da antibiyotik diren\u00e7 geni i\u00e7erir - ancak sahip oldu\u011fu genler, belirli antibiyotiklere kar\u015f\u0131 do\u011fal Enterococcus direnci ile ili\u015fkilidir.<\/p>\n\n\n\n<p>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>Bir ila\u00e7 olarak Enterococcus faecalis DSM 16440 onlarca y\u0131ld\u0131r \u00e7ok iyi \u00e7al\u0131\u015f\u0131lm\u0131\u015f ve genleri tamamen dizilenmi\u015ftir.<\/strong>&#8220; Verwandte Klone sind hingegen sequenziert und hinterlegt.<\/p>\n\n\n\n<p>\u0130malat\u00e7\u0131dan, bu \u00fcr\u00fcn\u00fcn t\u00fcm genom dizilimini istedim. <strong>Enterococcus faecalis DSM 16440<\/strong> talep edildi. Buna g\u00f6re g\u00fcncelleme yapaca\u011f\u0131m.<\/p>\n\n\n\n<p>Bu \u015fu demek: <strong>\u201eG\u00fcvenli\u201c probiyotik su\u015flar bile do\u011fal diren\u00e7 genlerini ba\u011f\u0131rsaktaki yabani E. faecalis'e aktarabilir.<\/strong> <strong>ge\u00e7mek<\/strong>.<\/p>\n\n\n\n<p>Makalede E. faecalis'in d\u00fcnya \u00e7ap\u0131nda en yayg\u0131n \u00e7oklu ilaca diren\u00e7li hastane patojenlerinden biri oldu\u011funun d\u00fc\u015f\u00fcn\u00fclmesinin nedeni de tam olarak budur.<\/p>\n\n\n\n<p>Bu da demek oluyor ki halihaz\u0131rda<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ampisilin<\/li>\n\n\n\n<li>Eritromisin<\/li>\n\n\n\n<li>Florokinolonlar<\/li>\n\n\n\n<li>Gentamisin<\/li>\n\n\n\n<li>Vankomisin<\/li>\n\n\n\n<li>muhtemelen birka\u00e7\u0131 bir arada<\/li>\n<\/ul>\n\n\n\n<p>dayan\u0131kl\u0131d\u0131r.<\/p>\n\n\n\n<p><em>E. faecalis<\/em> var <strong>do\u011fal<\/strong> Direni\u015fe:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Trimetoprim<\/li>\n\n\n\n<li>Linkozamidler (\u00f6rn. klindamisin)<\/li>\n<\/ul>\n\n\n\n<p>Yani <strong>i\u00e7sel<\/strong>, al\u0131nmad\u0131.<\/p>\n\n\n\n<p>(Ara\u015ft\u0131rman\u0131n 2010 y\u0131l\u0131ndaki durumu hakk\u0131nda daha fazla bilgi i\u00e7in bkz. <a href=\"https:\/\/www.clinicalmicrobiologyandinfection.org\/article\/S1198-743X(14)61686-4\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">Burada<\/a> tam metin olarak mevcuttur).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Risikofaktoren\"><\/span>Risk fakt\u00f6rleri<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Antibiyotik (a\u015f\u0131r\u0131) t\u00fcketimi<\/strong> disbiyoza neden olur<\/li>\n\n\n\n<li><strong>Ba\u011f\u0131rsak bariyeri bozukluklar\u0131<\/strong>, \u00f6rn. ba\u011f\u0131rsak ameliyat\u0131, iltihapl\u0131 ba\u011f\u0131rsak hastal\u0131klar\u0131 (IBD, Crohn hastal\u0131\u011f\u0131) ve yo\u011fun bak\u0131m \u00f6nlemleri (\u00f6rn. mide t\u00fcp\u00fc, kateter) nedeniyle<\/li>\n<\/ul>\n\n\n\n<p>Ba\u011f\u0131rsak \u201eyaralan\u0131rsa\u201c ve <em>E. faecalis<\/em> ba\u011f\u0131rsakta bulunursa, translokasyon riski artar.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Welche_Warnzeichen_gibt_es\"><\/span>Uyar\u0131 i\u015faretleri nelerdir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Bay Hyde sahneye \u00e7\u0131kt\u0131\u011f\u0131nda, bu genellikle \u015fu yollarla ger\u00e7ekle\u015fir<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Harnwegsinfektionen_UTI\"><\/span><strong>\u0130drar yolu enfeksiyonlar\u0131 (\u0130YE)<\/strong>.<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>\u0130YE'ler arac\u0131l\u0131\u011f\u0131yla <em>E. faecalis<\/em> \u00e7o\u011funlukla akuttur ve spesifik semptomlar\u0131n h\u0131zl\u0131 ba\u015flang\u0131c\u0131 nedeniyle te\u015fhis kolayd\u0131r:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u0130drar yaparken yanma hissi<\/li>\n\n\n\n<li>Daha s\u0131k idrara \u00e7\u0131kma (pollaki\u00fcri)<\/li>\n\n\n\n<li>Bulan\u0131k ve\/veya kanl\u0131 idrar<\/li>\n\n\n\n<li>Karn\u0131n alt k\u0131sm\u0131nda ve\/veya pelvik b\u00f6lgede a\u011fr\u0131<\/li>\n<\/ul>\n\n\n\n<p><strong>Dikkat<\/strong>ile <strong>ba\u011f\u0131\u015f\u0131kl\u0131k sistemi bask\u0131lanm\u0131\u015f hastalar<\/strong> (\u00f6rn. transplantasyondan sonra), semptomlar \u00e7ok daha hafiftir veya hi\u00e7 mevcut de\u011fildir. <em>sessiz ba\u011f\u0131\u015f\u0131kl\u0131k tepkisi<\/em> olduk\u00e7a spesifik olmayan (hatta hi\u00e7 olmayan) semptomlarla ili\u015fkilidir.<br>\u0130\u015fte <strong>\u00f6zel ilgiye ihtiyac\u0131 var!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Intraabdominelle_Infektionen_PeritonitisAbszesse\"><\/span>Kar\u0131n i\u00e7i enfeksiyonlar (peritonit\/abse)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>patojen kar\u0131n bo\u015flu\u011funa girdi\u011finde. Yo\u011fun bak\u0131m \u00fcnitelerindeki (YB\u00dc) enfeksiyonlar\u0131n yakla\u015f\u0131k 25%'sine \u015funlar neden olmaktad\u0131r <em>E. faecalis<\/em> neden oldu.<\/p>\n\n\n\n<p><strong>Pratik belirtiler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>\u015eiddetli kar\u0131n a\u011fr\u0131s\u0131<\/strong><\/li>\n\n\n\n<li><strong>Fieber &#8211; oft hoch &gt;38,5\u00b0C<\/strong><\/li>\n\n\n\n<li><strong>Mide bulant\u0131s\u0131 \/ kusma<\/strong><\/li>\n\n\n\n<li><strong>Peritonit belirtileri<\/strong> (klasik: korunma - kar\u0131na bas\u0131n\u00e7 uyguland\u0131\u011f\u0131nda kaslar hemen gerilir, geri tepme hassasiyeti - bas\u0131n\u00e7 aniden serbest b\u0131rak\u0131ld\u0131\u011f\u0131nda a\u015f\u0131r\u0131 a\u011fr\u0131)<\/li>\n<\/ul>\n\n\n\n<p><strong>Problem:<\/strong> Bu semptomlar genellikle a\u015fa\u011f\u0131dakilere \u00f6zg\u00fc de\u011fildir <em>E. faecalis<\/em>, ama daha yeni<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>bir kar\u0131n ameliyat\u0131<\/li>\n\n\n\n<li>Karaci\u011fer nakli<\/li>\n<\/ul>\n\n\n\n<p>ve sonra geli\u015ferek<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ate\u015f<\/li>\n\n\n\n<li>Kar\u0131n a\u011fr\u0131s\u0131<\/li>\n<\/ul>\n\n\n\n<p>olarak bilinir. <strong>E. faecalis i\u00e7in KIRMIZI BAYRAK<\/strong> yorumlamak i\u00e7in<strong>!<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Endokarditis\"><\/span>Endokardit<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>kalp kas\u0131 etkilendi\u011finde. \u015e\u00f6yle varsay\u0131l\u0131r <em>E. faecalis<\/em> art\u0131k hastane ortam\u0131 d\u0131\u015f\u0131nda edinilen endokardit vakalar\u0131n\u0131n 10-20%'sinden sorumludur.<\/p>\n\n\n\n<p><strong>Pratik belirtiler (klasik):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>\u0130nat\u00e7\u0131 ate\u015f<\/strong> (g\u00fcnler\/haftalar)<\/li>\n\n\n\n<li><strong>Ba\u015f d\u00f6nmesi, halsizlik, yorgunluk<\/strong><\/li>\n\n\n\n<li>Yeni veya k\u00f6t\u00fcle\u015fen <strong>patolojik<\/strong> <strong>Kalp \u00fcf\u00fcr\u00fcm\u00fc<\/strong><\/li>\n\n\n\n<li><strong>Petechiae<\/strong> (ciltte k\u00fc\u00e7\u00fck k\u0131rm\u0131z\u0131 noktalar - kanamalar)<\/li>\n\n\n\n<li><strong>Osler d\u00fc\u011f\u00fcm\u00fc<\/strong> (parmak u\u00e7lar\u0131nda\/ayak parmaklar\u0131nda a\u011fr\u0131l\u0131 nod\u00fcller)<\/li>\n\n\n\n<li><strong>Janeway lezyonlar\u0131<\/strong> (avu\u00e7 i\u00e7lerinde\/ayak tabanlar\u0131nda iyile\u015fmeyen k\u0131rm\u0131z\u0131 lekeler)<\/li>\n\n\n\n<li><strong>K\u0131ym\u0131k kanamalar\u0131<\/strong> (t\u0131rnaklar\u0131n alt\u0131nda k\u00fc\u00e7\u00fck kanamalar)<\/li>\n<\/ul>\n\n\n\n<p>A\u015fa\u011f\u0131dakilere ba\u011fl\u0131 endokardit <em>E. faecalis<\/em> olabilir <strong>Sessiz<\/strong> Yani yukar\u0131daki belirtilerden hi\u00e7biri g\u00f6r\u00fclmez.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Sepsis_%E2%80%93_Notfall-Szenarien\"><\/span>Sepsis - <strong>Acil durum senaryolar\u0131!<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Sistemik patojen istilas\u0131 durumunda, yani t\u00fcm organizma etkilenir.<\/p>\n\n\n\n<p><strong>Pratik belirtiler (<\/strong>SIRS kriterleri - <em>Sistemik \u0130nflamatuvar Yan\u0131t Sendromu<\/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>L\u00f6kositler<\/strong> (beyaz kan h\u00fccreleri)<strong> &gt;12.000 <\/strong>veya<strong> &lt;4.000<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>Septik \u015fok i\u00e7in<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Kan bas\u0131nc\u0131nda d\u00fc\u015fme (s\u0131v\u0131larla d\u00fczeltilemez)<\/strong><\/li>\n\n\n\n<li><strong>Organ yetmezli\u011fi (b\u00f6brekler, karaci\u011fer, akci\u011ferler)<\/strong><\/li>\n\n\n\n<li><strong>Bilin\u00e7 de\u011fi\u015fimi<\/strong><\/li>\n\n\n\n<li><strong>Ta\u015fikardi, terleme<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Gibt_es_keine_Alternativen\"><\/span>Alternatif yok mu?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Jain - etrafta bir ara\u015ft\u0131rma ekibi olmas\u0131na ra\u011fmen <em>Mar\u00eda C. Urdaci, Laboratoire de Microbiologie et Biochimie Appliqu\u00e9e (LBMA), Universit\u00e9 de Bordeaux, Fransa<\/em>, ile ilgilenen <em>E. durans EP1<\/em> ile ilgileniyor:<\/p>\n\n\n\n<p>E. durans EP1 su\u015fu EFSA taraf\u0131ndan belirlenen gereklilikleri kar\u015f\u0131lamaktad\u0131r. E. durans EP1 anti-enflamatuar \u00f6zellikler g\u00f6stermi\u015f, 7 g\u00fcn sonra mezenterik lenf d\u00fc\u011f\u00fcmlerinde IgA h\u00fccrelerini art\u0131rm\u0131\u015f ve Faecalibacterium prausnitzii'yi art\u0131rarak mikrobiyomu mod\u00fcle etmi\u015ftir. Ayr\u0131ca, bu kar\u015f\u0131la\u015ft\u0131rmal\u0131 \u00e7al\u0131\u015fmada oldu\u011fu gibi, 21 g\u00fcn boyunca EP1 alan farelerde hi\u00e7bir yan etki g\u00f6zlenmemi\u015ftir <em><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17466591\/\" target=\"_blank\" rel=\"noreferrer noopener\">Probiyotik Enterococcus faecalis su\u015fu Symbioflor 1'de potansiyel enterokok vir\u00fclans fakt\u00f6rlerinin varl\u0131\u011f\u0131 i\u00e7in kar\u015f\u0131la\u015ft\u0131rmal\u0131 genomik analiz<\/a><\/em> dolu.<\/p>\n\n\n\n<p>E. duran'\u0131n OSY-EGY'si, Truva at\u0131 gibi \u201ek\u00f6t\u00fc\u201c kod i\u00e7erebilecek plazmidlere sahip de\u011fildir (bkz. yukar\u0131daki USB bellek) ve bunlar\u0131 bar\u0131nd\u0131ramaz ve genomu, faj modifikasyonuna ve yatay gen transferine kar\u015f\u0131 sekans bazl\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k sa\u011flayan bir do\u011frulanm\u0131\u015f ve \u00fc\u00e7 potansiyel CRISPR dizisi i\u00e7erir.<\/p>\n\n\n\n<p>Kan\u0131tlanm\u0131\u015f - \u00f6zellikle g\u00fcvenlikle ilgili - t\u00fcm avantajlar\u0131na ra\u011fmen, ticari bir \u00fcr\u00fcn mevcut de\u011fildir.<\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Okuma s\u00fcresi<\/span> <span class=\"rt-time\"> 8<\/span> <span class=\"rt-label rt-postfix\">dakika<\/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\/tr\/blog\/2026\/03\/18\/chronische-bronchitis-symbioflor\/\" rel=\"bookmark\">Daha fazlas\u0131n\u0131 oku \"<span class=\"screen-reader-text\">Kronik bron\u015fit - 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\/tr\/wp-json\/wp\/v2\/posts\/13123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/comments?post=13123"}],"version-history":[{"count":3,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/posts\/13123\/revisions"}],"predecessor-version":[{"id":13408,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/posts\/13123\/revisions\/13408"}],"wp:attachment":[{"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/media?parent=13123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/categories?post=13123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csiag.eu\/tr\/wp-json\/wp\/v2\/tags?post=13123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}