Na dotazy P\u0159\u00edbramsk\u00e9ho den\u00edku odpov\u00eddal mikrobiolog P\u0159\u00edbramsk\u00e9 nemocnice Petr Je\u017eek. \u010cten\u00e1\u0159i se zaj\u00edmali p\u0159edev\u0161\u00edm o antibiotika a jejich vliv na lidsk\u00fd organismus.
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\n– M\u016fj sedmilet\u00fd syn trp\u00ed neust\u00e1l\u00fdmi anginami, i \u0161estkr\u00e1t do roka. M\u00e1m z p\u0159ehnan\u00e9ho u\u017e\u00edv\u00e1n\u00ed penicilinu ji\u017e strach. M\u016f\u017ee ho to n\u011bjak po\u0161kodit? Laboratorn\u011b je v\u0161e v po\u0159\u00e1dku.<\/p>\n
Penicilinov\u00e1 antibiotika pat\u0159\u00ed meze nejbezpe\u010dn\u011bj\u0161\u00ed. Z po\u0161kozen\u00ed zdrav\u00ed syna nen\u00ed t\u0159eba m\u00edt strach. Opakovan\u00e9 ang\u00edny u d\u011bt\u00ed nejsou v\u00fdjimkou. Vypl\u00fdv\u00e1 to z \u00fazk\u00e9ho kontaktu d\u011bt\u00ed ve \u0161kolce (ve \u0161kole), kde doch\u00e1z\u00ed ke snadn\u00e9mu p\u0159enosu p\u016fvodc\u016f, ale p\u0159\u00ed\u010diny mohou b\u00fdt i jinde, nap\u0159\u00edklad v poru\u0161e imunitn\u00edho syst\u00e9mu.<\/p>\n
– Co si mysl\u00edte o nasazov\u00e1n\u00ed antibiotik bez p\u0159ede\u0161l\u00e9ho lab. vy\u0161et\u0159en\u00ed posti\u017een\u00e9 sliznice? Je v po\u0159\u00e1dku, \u017ee l\u00e9ka\u0159 p\u00ed\u0161e atb podle fyzik\u00e1ln\u00edho vy\u0161et\u0159en\u00ed?<\/p>\n
Hnisav\u00e9 ang\u00edny obvykle prakti\u010dt\u00ed l\u00e9ka\u0159i pom\u011brn\u011b snadno oddiagnostikuj\u00ed podle fyzik\u00e1ln\u00edho vy\u0161et\u0159en\u00ed, nicm\u00e9n\u011b p\u0159esto by m\u011bl l\u00e9ka\u0159 v\u017edy prov\u00e9st v\u00fdt\u011br z krku a zaslat jej na mikrobiologick\u00e9 vy\u0161et\u0159en\u00ed pro potvrzen\u00ed. V tomto p\u0159\u00edpad\u011b pak m\u00e1 p\u0159esnou informaci o p\u016fvodci \u010di p\u016fvodc\u00edch a m\u016f\u017ee n\u00e1sledn\u011b svou l\u00e9\u010dbu up\u0159esnit nebo upravit. Ne ka\u017ed\u00e9 posti\u017een\u00ed sliznice je bakteri\u00e1ln\u00edho p\u016fvodu, velmi \u010dasto se uplat\u0148uj\u00ed virov\u00e1 agens a v tomto p\u0159\u00edpad\u011b je nasazen\u00ed antibiotik kontraindikov\u00e1no. N\u011bkte\u0159\u00ed l\u00e9ka\u0159i mohou v tomto rozhodov\u00e1n\u00ed vyu\u017e\u00edt stanoven\u00ed CRP (C reaktivn\u00ed protein) p\u0159\u00edmo v ordinaci, jeho\u017e hodnota s velkou p\u0159esnost\u00ed nazna\u010d\u00ed, zda jde o bakteri\u00e1ln\u00ed \u010di virov\u00e9 onemocn\u011bn\u00ed. V\u00fdsledek je k dispozici t\u00e9m\u011b\u0159 ihned a l\u00e9ka\u0159 m\u016f\u017ee s velkou pravd\u011bpodobnost\u00ed zjistit, zdali jde o bakteri\u00e1ln\u00ed \u010di virov\u00e9 onemocn\u011bn\u00ed, a podle toho nasadit antibiotika \u010di nikoliv.<\/p>\n
– Jak mohu zlikvidovat zlat\u00e9ho stafylokoka v krku?<\/p>\n
P\u0159edpokl\u00e1d\u00e1m, \u017ee jde o dlouhodobou p\u0159\u00edtomnost tohoto agens v t\u00e9to lokalit\u011b bez projev\u016f infekce. Pak se lze domn\u00edvat, \u017ee jde u V\u00e1s z\u0159ejm\u011b o nosi\u010dstv\u00ed, kter\u00fdm trp\u00ed zhruba 30 procent populace. Eradikace (vym\u00fdcen\u00ed choroby z populace) je velmi obt\u00ed\u017en\u00e1 a obvykle kon\u010d\u00ed ne\u00fasp\u011bchem. Pouze asi 10 procent nosi\u010d\u016f se povede zbavit stafylokoka trvale. Ostatn\u00edm se d\u0159\u00edve \u010di pozd\u011bji nosi\u010dstv\u00ed vr\u00e1t\u00ed. Nicm\u00e9n\u011b je dobr\u00e9 v\u011bd\u011bt, \u017ee jsem nosi\u010d a v p\u0159\u00edpad\u011b jak\u00fdchkoliv hnisav\u00fdch proces\u016f (nej\u010dast\u011bji b\u00fdvaj\u00ed na k\u016f\u017ei) informovat l\u00e9ka\u0159e, kter\u00fd pak m\u016f\u017ee zac\u00edlit l\u00e9\u010dbu na tohoto patogena. To plat\u00ed i p\u0159i v\u00fdskytu u ostatn\u00edch \u010dlen\u016f rodiny nebo lid\u00ed v \u00fazk\u00e9m kontaktu. Tak\u00e9 je t\u0159eba si uv\u011bdomit, \u017ee vlastn\u011b dlouhodob\u011b kontaminujeme sv\u00e9 obydl\u00ed a \u017ee je budeme nejsp\u00ed\u0161 m\u00edt i v prost\u0159ed\u00ed, a je proto vhodn\u00e9 dodr\u017eovat \u00fazkostliv\u011bji hygienu rukou p\u0159\u00edp. pou\u017e\u00edvat i dezinfek\u010dn\u00ed prost\u0159edky na ruce a alespo\u0148 dvakr\u00e1t za den si ruce vydezinfikovat. Jinak krom\u011b antibiotik existuj\u00ed i r\u016fzn\u00e1 kloktadla.<\/p>\n
– Ke zlat\u00e9mu stafylokokovi jsem p\u0159i\u0161la pobytem ve „va\u0161\u00ed“ nemocnici, co d\u011bl\u00e1 nemocnice proto, aby k tomu nedoch\u00e1zelo?<\/p>\n
Je velmi t\u011b\u017ek\u00e9 prok\u00e1zat, \u017ee jste p\u0159i\u0161la k tomuto mikroorganismu v nemocnici, proto\u017ee v\u00fdskyt tohoto patogena v populaci je velmi vysok\u00fd a z Va\u0161eho dotazu nemohu tuto skute\u010dnost zodpov\u011bdn\u011b posoudit. I v p\u0159\u00edpad\u011b, \u017ee m\u00e1te prok\u00e1z\u00e1no, \u017ee nejste sama nosi\u010dem (nej\u010dast\u011bji b\u00fdv\u00e1 v nose \u010di krku \u2013 viz tak\u00e9 p\u0159edchoz\u00ed dotaz), nelze mnohdy z\u00edsk\u00e1n\u00ed tohoto druhu v nemocnici spolehliv\u011b prok\u00e1zat. Nicm\u00e9n\u011b i takov\u00e1 mo\u017enost samoz\u0159ejm\u011b existuje. T\u011bmto infekc\u00edm se \u0159\u00edk\u00e1 infekce spojen\u00e9 se zdravotn\u00ed p\u00e9\u010d\u00ed a vyskytuj\u00ed se ve v\u0161ech zdravotnick\u00fdch za\u0159\u00edzen\u00edch na cel\u00e9m sv\u011bt\u011b, nejen u n\u00e1s. Jejich v\u00fdskyt je r\u016fzn\u011b vysok\u00fd podle toho, jak se nemocnice tomuto probl\u00e9mu v\u011bnuje. V na\u0161\u00ed nemocnici je za t\u00edmto \u00fa\u010delem ustanovena skupina odborn\u00edk\u016f, kter\u00e1 se takov\u00fdm infekc\u00edm v\u011bnuje a sna\u017e\u00ed se je eliminovat na co nejmen\u0161\u00ed m\u00edru. Bezpe\u010dnost pacient\u016f je jedno ze z\u00e1kladn\u00edch krit\u00e9ri\u00ed kvality p\u00e9\u010de v ka\u017ed\u00e9 nemocnici, a proto se mu u n\u00e1s v\u011bnuje velk\u00e1 pozornost. Nap\u0159\u00edklad v p\u0159\u00ed\u0161t\u00edm roce budou prob\u00edhat i n\u011bkter\u00e9 studie zab\u00fdvaj\u00edc\u00ed se touto problematikou. Krom\u011b toho pravideln\u011b prov\u00e1d\u00edme st\u011bry z rukou person\u00e1lu, proto\u017ee pr\u00e1v\u011b ruce zdravotn\u00edk\u016f mohou b\u00fdt \u010dasto zdrojem takov\u00fdch infekc\u00ed. Do budoucna se t\u00e9to problematice rozhodn\u011b budeme v\u011bnovat je\u0161t\u011b hloub\u011bji tak, aby nebezpe\u010d\u00ed na\u0161ich pacient\u016f v tomto sm\u011bru bylo co nejmen\u0161\u00ed.<\/p>\n
– Kdy se vytv\u00e1\u0159\u00ed opravdov\u00e1 rezistence na antibiotika a co znamen\u00e1 zneu\u017e\u00edv\u00e1n\u00ed antibiotik?<\/p>\n
Vznik rezistence (odolnosti) na antibiotika ovliv\u0148uje v\u00edce faktor\u016f. Nejv\u00edce se v\u0161ak uplat\u0148uje jejich neuv\u00e1\u017een\u00e9 pod\u00e1v\u00e1n\u00ed, \u010d\u00edm\u017e vznik\u00e1 velk\u00fd tlak t\u011bchto l\u00e1tek v ekosyst\u00e9mu, kde se bakterie vyskytuj\u00ed a ty se jim pak br\u00e1n\u00ed r\u016fzn\u00fdmi mechanismy. Nap\u0159\u00edklad t\u00edm, \u017ee si vytv\u00e1\u0159\u00ed enzymy, kter\u00fdmi znemo\u017e\u0148uj\u00ed p\u016fsobit t\u011bmto l\u00e9k\u016fm ve sv\u00e9m organismu nebo um\u00ed molekuly antibiotika ze sv\u00e9ho organismu doslova vyplivnout mimo sv\u00e9 t\u011blo. Takov\u00fdch mechanism\u016f je v\u0161ak cel\u00e1 \u0159ada. Zneu\u017e\u00edv\u00e1n\u00ed antibiotik znamen\u00e1 pr\u00e1v\u011b jejich nadm\u011brn\u00e9 u\u017e\u00edv\u00e1n\u00ed zejm\u00e9na tam, kde nen\u00ed pot\u0159eba. Nej\u010dast\u011bj\u0161\u00edm p\u0159\u00edkladem jsou infekce d\u00fdchac\u00edch cest v podzimn\u00edm a zimn\u00edm obdob\u00ed, kde se velmi \u010dasto uplat\u0148uj\u00ed viry, na kter\u00e9 tyto l\u00e1tky ne\u00fa\u010dinkuj\u00ed. Zde se nejv\u00edce chybuje. Bohu\u017eel je prok\u00e1z\u00e1no, \u017ee takov\u00fdch p\u0159\u00edpad\u016f nec\u00edlen\u00e9 antibioterapie je ka\u017edoro\u010dn\u011b velmi mnoho nejen u infekc\u00ed d\u00fdchac\u00edch cest. Mnohdy si antibiotika na l\u00e9ka\u0159i vym\u00e1haj\u00ed sami pacienti, co\u017e je zcela nep\u0159ijateln\u00e9 a nepochopiteln\u00e9. Rozhodnut\u00ed o takov\u00e9 l\u00e9\u010db\u011b by rozhodn\u011b m\u011blo b\u00fdt pouze v kompetenci l\u00e9ka\u0159e. Dobr\u00fd l\u00e9ka\u0159 by tak\u00e9 m\u011bl um\u011bt v p\u0159\u00edpad\u011b podez\u0159en\u00ed na bakteri\u00e1ln\u00ed infekci spr\u00e1vn\u011b rozhodnout. D\u016fle\u017eit\u00e9 je v tomto sm\u011bru nap\u0159. i oby\u010dejn\u00e9 dodr\u017eov\u00e1n\u00ed l\u00e9ka\u0159em nastaven\u00e9 l\u00e9\u010dby antibiotiky, a to jak ve smyslu d\u00e1vkov\u00e1n\u00ed, tak i celkov\u00e9 doby u\u017e\u00edv\u00e1n\u00ed. A pr\u00e1v\u011b t\u00edm m\u016f\u017ee p\u0159isp\u011bt ka\u017ed\u00fd z n\u00e1s.<\/p>\n
– Kdy je vhodn\u00e9 nasadit antibiotika a jak dlouho m\u00e1me s onemocn\u011bn\u00edm \u010dekat?<\/p>\n
Nen\u00ed v\u017edy zcela jednoduch\u00e9 a jednozna\u010dn\u00e9, kdy antibiotika ano a kdy nikoliv. Obvykle o nasazen\u00ed antibiotik rozhoduj\u00ed klinick\u00e9 a laboratorn\u00ed zn\u00e1mky p\u0159\u00edtomnosti infekce. V takov\u00e9m p\u0159\u00edpad\u011b je vhodn\u00e9 nasazovat l\u00e9\u010dbu neprodlen\u011b. U lehk\u00fdch a nejasn\u00fdch p\u0159\u00edpad\u016f infekc\u00ed je n\u011bkdy vhodn\u00e9 vy\u010dkat na v\u00fdsledky mikrobiologick\u00e9ho vy\u0161et\u0159en\u00ed. To v\u0161ak trv\u00e1 i n\u011bkolik dn\u00ed a proto se ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f antibioterapie nasazuje hned, samoz\u0159ejm\u011b pokud pacient vykazuje zn\u00e1mky bakteri\u00e1ln\u00ed infekce. Jsou-li pak v\u00fdsledky vy\u0161et\u0159en\u00ed ji\u017e k dispozici, je mo\u017en\u00e9 l\u00e9\u010dbu upravit, nebo jeli spr\u00e1vn\u011b nasazen\u00e1, ponechat.<\/p>\n
Mark\u00e9ta Jankovsk\u00e1
\nP\u0159\u00edbramsk\u00fd den\u00edk<\/p>\n","protected":false},"excerpt":{"rendered":"
Na dotazy P\u0159\u00edbramsk\u00e9ho den\u00edku odpov\u00eddal mikrobiolog P\u0159\u00edbramsk\u00e9 nemocnice Petr Je\u017eek. \u010cten\u00e1\u0159i se zaj\u00edmali p\u0159edev\u0161\u00edm o antibiotika a jejich vliv na lidsk\u00fd organismus.<\/p>\n<\/div>","protected":false},"author":1,"featured_media":14127,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-13500","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/13500","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13500"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/13500\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14127"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13500"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13500"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13500"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}