Antibioticka rezistence u kmenu Streptococcus agalacctiae izolovanych od gravidnich z en a novorozencu v letech 2001-2002

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Profylakticke nitrozilni podani penicilinu nebo ampicilinu nosickam Streptococcus agalactiae v prubehu porodu snizuje vyskyt casnych novorozeneckych invazivnich infekci zpusobenych timto druhem bakterie az o 50 %. V nasem souboru izolatu S. agalactiae od 265 novorozencu a 204 gravidnich zen nebyla prokazana rezistence ani smzena citlivost k temto antibiotikum. Alternativnimi antibiotiky pri precitlivelosti zen k penicilinu jsou erytromycin, a zejmena klindamycin pro vyhodnejsi farmakokineticke parametry. Rezistence k erytromycinu byla zjistena u 4,4 % izolatu od gravidnich zen a v temer dvojnasobne vyssi frekvenci u neinvazivnich (7,0 %) a invazivnich kmenu (8,5 %) izolovanych od novorozencu. Kmeny rezistentni k erytromycinu byly s vyjimkou jednoho kmene soucasne rezistentni take ke klindamycinu. Prevaha izolatu S. agalactiae rezistentnich k erytromycinu (65,5 %) pfislusela k serotypu V.Pri volbe profylaxe infekci zpusobenych S. agalactiae u novorozencu je treba dat vzdy prednost penicilinu nebo ampicilinu pro jejich bezvyhradnou ucinnost. Chybny vysledek laboratormlio vysetrem, ktery oznaci citlivy kmen S. agalactiae jako rezistentni k penicilinu, nebo neprovereni nadhodnocenych udaju gravidnich zen o jejich alergii k penicilinu zbytecne vedou k volbe alternativniho antibiotika. Je vsak treba zduraznit, ze ucinnost erytromycinu a klindamycinu nevi jista pro moznost vyskytu rezistentnich kmenu.

Klíčová slova:

Antibiotic Resistance of Strains of Streptococcus agalactiae Isolated from Pregnant Women and Neonates in 2001-2002

Prophylactic intravenous penicillin or ampicillin administration to carriers of Streptococcus agalactiae during childbirth reduces the incidence of early neonatal invasive infections caused by these bacteria by as much as 50%. In our group of isolates of S. agalactiae from 265 neonates and 204 pregnant women neither resistance nor reduced sensitivity to these antibiotics was proved. Alternative antibiotics in case of hypersensitivity of women to penicillin are erythromycin and in particular clindamycin because of more favourable pharmacokinetic parameters. Resistance to erythromycin was found in 4.4% isolates from pregnant women with an almost double frequency of non-invasive (7.0%) as compared with invasive strains (8.5%) isolated from neonates. Strains resistant to erythromycin were with the exception of one strain also resistant to clindamycin. The majority of isolates of S. agalactiae resistant to erythromycin (65.5%) belonged to serotype V.When selecting effective prophylaxis of infections caused by S. agalactiae in neonates always effective. Erroneous results of laboratory examination which describe a sensitive strain of S. agalactiae as penicillin resistant or omission of testing exaggerated data from pregnant women on their allergy to penicillin lead unnecessarily to selection of an alternative antibiotic. It must be however emphasized that the effectiveness of erythromycin and clindamycin is not certain because of the possible occurrence of resistant strains.

Key words:
neonatal infections - Streptococcus agalactiae - antibiotic resistance.

Autoři: Urbaskova P.'; Motlova J.'; Strakova L.'; P. Sak ²; T. Sever ³; M. Balejova ²; M. Bártová ³
Působiště autorů: ICentrum epidemiologie a mikrobiologie, Stdtni zdravotni ustav, Praha 2Nemocnice Ceske Budejovice 3Thomayerova nemocnice, Praha
Vyšlo v časopise: Prakt. Lék. 2003; (4): 203-207
Kategorie: Články