1-tis sintaxis.
qxd 14/10/2009 2:16 Page 171
¢ñèñï óýíôáîçò
Ç ãåíåôéêÞ ðñïÝëåõóç êáé ç äõíáìéêÞ ôïõ íÝïõ éïý ôçò ãñßðçò Á
(Ç1Í1): íåüôåñá äåäïìÝíá
Ã. Âñõþíç, Á. ÔóáêñÞò
ÅñãáóôÞñéï Ìéêñïâéïëïãßáò, ÉáôñéêÞ Ó÷ïëÞ, ÐáíåðéóôÞìéï Áèçíþí
Ï íÝïò éüò ôçò ãñßðçò Á (Ç1Í1), ç ðáñïõóßá
ôïõ ïðïßïõ åðéâåâáéþèçêå ùò áßôéï åðéäçìßáò
ôïí Áðñßëéï 2009, åßíáé ðëÝïí ðáãêüóìéá áðåéëÞ.
ÉóôïñéêÜ, ðáíäçìßåò ãñßðçò óõìâáßíïõí üôáí
Ýíá íÝï óôÝëå÷ïò éïý ãñßðçò ìåôáöÝñåôáé áðü
êÜðïéï åßäïò æþïõ, üðùò ÷ïßñïé, êïôüðïõëá,
ðÜðéåò, óôïí Üíèñùðï.1 Óôç äçìéïõñãßá ôïõ íÝ-
ïõ éïý óçìáíôéêü ñüëï Ýðáéîáí ïé ÷ïßñïé, ïé
ïðïßïé, áðü ðáëéÜ ëåéôïõñãïýí ùò "äï÷åßï ãåíå-
ôéêÞò ìßîçò" äéáöüñùí éþí ãñßðçò êáé äçìéïõñ-
ãßáò íÝùí õðüôõðùí ìÝóù áíôéãïíéêÞò
ìåôáâïëÞò (antigenic shift), äçëáäÞ áíôéêáôÜ-
óôáóçò ôìçìÜôùí RNA.2,3
Óôï íÝï éü ôçò ãñßðçò Á (Ç1Í1), äýï ãïíßäéá
[ôá ãïíßäéá ôçò íåõñáìéíéäÜóçò (ÍÁ) êáé ôçò
ðñùôåÀíçò ðåñéâëÞìáôïò (Ì)] ðñïÞëèáí áðü
ôïí éü ôçò ãñßðçò ôùí ÷ïßñùí ðïõ êõêëïöïñïý-
óå óôçí ðåñéï÷Þ ôçò Åõñáóßáò áðü ôï 1979 êáé
ôá õðüëïéðá Ýîé ãïíßäéá [ôá ãïíßäéá ôçò ðïëõìå-
ñÜóç (ÑÂ2, ÑÂ1, ÑÁ), ôçò áéìïóõãêïëëçôßíçò
Yðåýèõíïò áëëçëïãñáößáò
Ãåùñãßá Âñõþíç
ÅñãáóôÞñéï Ìéêñïâéïëïãßáò
ÉáôñéêÞ Ó÷ïëÞ Áèçíþí
Ì. Áóßáò 75, ÃïõäÞ
Ôçë.: 210-7462129
e-mail: gvrioni@med.uoa.gr
171
(ÇÁ), ôçò íïõêëåïðñùôåÀíçò (ÍÑ) êáé ôùí ìç äï-
ìéêþí ðñùôåúíþí (ÍS)] áðü ôïí ôñéðëÜ áíáóõí-
äõáóìÝíï éü ôùí ÷ïßñùí ôçò Âïñåßïõ ÁìåñéêÞò
Ç1Í2, ðïõ êõêëïöïñïýóå óå üëï ôïí êüóìï
áðü ôï 1998.4,5,6 ÅðåéäÞ, ï ôñéðëÜ áíáóõíäõá-
óìÝíïò éüò ôùí ÷ïßñùí ôçò Âïñåßïõ ÁìåñéêÞò
Ç1Í2 ðåñéÝ÷åé ãïíßäéá áðü ôïõò éïýò ãñßðçò
ôùí ðôçíþí (ÑÂ2, ÑÁ), ôïí "êëáóéêü" éü ãñßðçò
ôùí ÷ïßñùí Ç1Í1 (Ì, ÍÑ, NS, HA) êáé ôïí éü ãñß-
ðçò ôïõ áíèñþðïõ Ç3Í2 (ÑÂ1, ÍÁ), áñ÷éêÜ èå-
ùñÞèçêå üôé ï íÝïò éüò ôçò ãñßðçò Á (Ç1Í1)
Þôáí áíáóõíäõáóìüò ôùí áíôßóôïé÷ùí éþí ãñß-
ðçò ôùí ÷ïßñùí, ôùí ðôçíþí êáé ôùí áíèñþ-
ðùí.7 ÖõëïãåíåôéêÝò ìåëÝôåò, üìùò, áíÜëõóçò
Ýäåéîáí üôé ôá ãïíßäéá ôïõ íÝïõ éïý ðáñïõóéÜ-
æïõí ìåãÜëç ïìïéüôçôá ìå áõôÜ ðïõ êõêëïöï-
ñïýóáí ôá ðñïçãïýìåíá ÷ñüíéá óôïõò ÷ïßñïõò,
ìå áñêåôÝò äéáöïñÝò áðü ôá áíôßóôïé÷á ãïíßäéá
ôùí éþí ôçò åðï÷éêÞò ãñßðçò Á (Ç1Í1) êáé ôçò
éóðáíéêÞò ãñßðçò ôïõ 1918,8,9 åíþ, ôåëéêÜ, ç áñ-
ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
1-tis sintaxis.qxd 14/10/2009 2:16 Page 172
Ã. ÂÑÕÙÍÇ, Á. ÔÓÁÊÑÇÓ
÷éêÞ ðñïÝëåõóç ôùí ðÝíôå ãïíéäßùí (ÑÂ2, ÑÂ1, ÑÁ,
ÍÁ êáé Ì) ôïõ íÝïõ éïý âñßóêåôáé óôïõò éïýò ãñßðçò
ôùí ðôçíþí êáé ôï ÑÂ1 ãïíßäéï åß÷å Ýíá åðéðëÝïí ðÝ-
ñáóìá áðü ôïí áíèñþðéíï ðëçèõóìü (Åéêüíá 1).6
Áí êáé äåí åßíáé ãíùóôü ôï ðüôå áêñéâþò Ýãéíå ï
ôåëéêüò áíáóõíäõáóìüò, ç åîåëéêôéêÞ éóôïñßá ôïõ
íÝïõ éïý ôçí ôåëåõôáßá äåêáåôßá, ðñéí ìðåé óôïí áí-
èñþðéíï ïñãáíéóìü, åßíáé áñêåôÜ ðïëýðëïêç. Ãéá
ðïëëÝò äåêáåôßåò ï "êëáóéêüò" éüò ãñßðçò ôùí ÷ïß-
ñùí ôçò Âïñåßïõ ÁìåñéêÞò Ç1Í1 ìåôáëëáóóüôáí
ó÷åôéêÜ áñãÜ,10 ðñïêáëþíôáò åðéäçìßåò óôá êïðÜ-
äéá ôùí ÷ïßñùí, ìå ìåãÜëç íïóçñüôçôá êáé ìéêñÞ
èíçôüôçôá (1-4%),11 êáé óðÜíéá, "óðÜæïíôáò" ôï
öñÜãìá ôùí åéäþí, óðïñáäéêÜ êñïýóìáôá óôïí Üí-
èñùðï.12 ÏìÜäåò õøçëïý êéíäýíïõ Þôáí Üôïìá
ðïõ âñßóêïíôáí óå óôåíÞ ìå åðáöÞ ìå ÷ïßñïõò,
üðùò ïé êôçíïôñüöïé. ¸ôóé, áðü ôá ìÝóá ôïõ 20ïõ
áéþíá Ý÷ïõí êáôáãñáöåß ðåñßðïõ 50 ôÝôïéåò ëïéìþ-
îåéò, ìå êëéíéêÞ åéêüíá ßäéá üðùò êáé ôçò åðï÷éêÞò
ãñßðçò, åíþ óðÜíéá Þôáí ç ìåôÜäïóç áðü Üíèñùðï
óå Üíèñùðï.12 ÓïâáñÞ åðéäçìßá áðü ôïí "êëáóéêü"
éü ôùí ÷ïßñùí Ç1Í1 óõíÝâç ôï 1976 óå óôñáôéþôåò
óôï Fort Dix ôïõ New Jersey ôùí ÇÐÁ, üðïõ êáôá-
172
Åéêüíá 1. Ó÷çìáôéêÞ ðáñÜóôáóç ôçò ãåíåôéêÞò åîÝëéîçò ôïõ íÝïõ éïý ôçò ãñßðçò Á (Ç1Í1) (ÐñïóáñìïãÞ áðü Morens DM et al., 2009).
VOL. 54 • ISSUE 4, July - August 2009
ãñÜöçêáí 230 êñïýóìáôá êáé õðÞñîå Ýíáò èÜíá-
ôïò (Åéêüíá 1).13 Ôï 1997 åìöáíßæåôáé Ýíáò íÝïò
áíáóõíäõáóìÝíïò éüò, ìå ôñßá ãïíßäéá áðü ôïí áí-
èñþðéíï éü ãñßðçò Ç3Í2 (ôá ÇÁ, ÍÁ êáé ÑÂ1), êáé
óýíôïìá ìåôÜ áðü áõôü ôï ãåãïíüò, ï ôñéðëÜ áíá-
óõíäõáóìÝíïò éüò ôùí ÷ïßñùí Ç3Í2, ìå äýï ãïíß-
äéá (ôá ÑÁ êáé ÑÂ2) ðñïåñ÷üìåíá áðü ôïõò éïýò
ãñßðçò ôùí ðôçíþí.14 Áõôüò åîáðëþèçêå ãñÞãïñá
óôïí ðëçèõóìü ôùí ÷ïßñùí, õðÝóôç êáéíïýñãéï
áíáóõíäõáóìü ìå ôïí "êëáóéêü" éü ôùí ÷ïßñùí
Ç1Í1, ëáìâÜíïíôáò áðü áõôüí ôï ÇÁ ãïíßäéï, ìå
áðïôÝëåóìá íá äçìéïõñãçèåß ï ôñéðëÜ áíáóõíäõá-
óìÝíïò éüò ôùí ÷ïßñùí Â. ÁìåñéêÞò Ç1Í2.15 Áõôüò
ðñïêÜëåóå óðïñáäéêÜ êñïýóìáôá óôïí Üíèñùðï:
ôï ðñþôï ðåñéóôáôéêü óôéò ÇÐÁ êáôáãñÜöçêå ôï
2005 êáé, ìÝ÷ñé ôï ÖåâñïõÜñéï 2009, êáôáãñÜöç-
êáí áêüìç Ýíôåêá ðåñéóôáôéêÜ.7 Åêôüò áðü ôïõò
ðáñáðÜíù áíáóõíäõáóìïýò, óõãêñéôéêÞ ìåëÝôç
ìÝóù çëåêôñïíéêïý õðïëïãéóôÞ üëùí ôùí ìÝ÷ñé ôþ-
ñá ÇÁ êáé ÍÁ íïõêëåïôéäéêþí áêïëïõèéþí Ýäåéîå
üôé óôçí ÔáúëÜíäç, ìåôáîý 2000 êáé 2006 õðÞñîáí
äýï áêüìç åßäç áíáóõíäõáóìþí, áõôÞ ôç öïñÜ ìå
ôï éü ôùí ÷ïßñùí ôçò Åõñáóßáò: óôïí Ýíáí áíáóõí-
1-tis sintaxis.qxd 14/10/2009 2:16 Page 173

Ç ÃÅÍÅÔÉÊÇ ÐÑÏÅËÅÕÓÇ ÊÁÉ??????

?????? Ç ÄÕÍÁÌÉÊÇ ÔÏÕ????
???????? ÍÅÏÕ???????
ÉÏÕ ÔÇÓ????????????
ÃÑÉÐÇÓ Á (Ç1Í1):
???ÍÅÏÔÅÑÁ ÄÅÄÏÌÅÍÁ
Blastocystis sp.

äõáóìü ôá ÇÁ êáé ÍS ãïíßäéá ðñïÞëèáí áðü ôïí
"êëáóéêü" Ç1Í1 êáé ôá õðüëïéðá áðü ôïí éü ôçò Åõ-
ñáóßáò, êáé óôïí Üëëï áíáóõíäõáóìü ìüíï ôï ÇÁ
áðü ôïí "êëáóéêü" Ç1Í1 êáé ôá õðüëïéðá áðü ôïí
éü ôçò Åõñáóßáò.15 Ïé éïß áõôïß ðñïêÜëåóáí ðïëëá-
ðëÝò ëïéìþîåéò óôïõò ÷ïßñïõò ôçò ÔáúëÜíäçò, åíþ
áíáöÝñèçêå êáé Ýíá êñïýóìá óå Üíèñùðï.16,17
Åíþ, üìùò, üëïé ïé ðáñáðÜíù áíáóõíäõáóìïß
äåí ðñïêÜëåóáí ðáíäçìßåò óôïõò áíèñþðïõò, ãå-
íåôéêÝò äéáäéêáóßåò èåôéêÞò åðéëïãÞò êáé åêëåêôéêÞò
áíôáëëáãÞò ãåíåôéêïý õëéêïý ðïõ óõíÝâçóáí óôç
óõíÝ÷åéá, þèçóáí ôï íÝï éü óôçí ðñüóöáôÞ ôïõ åîÝ-
ëéîç, ìå áðïôÝëåóìá ôï "óðÜóéìï" ôïõ öñÜãìáôïò
ôùí åéäþí, ôç ìåôáðÞäçóÞ ôïõ óôïí áíèñþðéíï ðëç-
èõóìü êáé ôçí éêáíüôçôá ìåôÜäïóÞò ôïõ áðü Üí-
èñùðï óå Üíèñùðï.8,15 ÁíÜëïãï öáéíüìåíï Ý÷åé,
åîÜëëïõ, ðáñáôçñçèåß ìå ôïí éü SARS-CoV, ìå ôïí
ïðïßï ðéóôåýåôáé üôé Ý÷åé áêïëïõèÞóåé ðáñüìïéá
ðïñåßá åîÝëéîçò.8 ÅâäïìÞíôá Ýîé ìïíáäéêÝò ìåôáë-
ëáãÝò ðïõ âñÝèçêáí óôïí íÝï éü ôçò ãñßðçò Á
(Ç1Í1) (9 óôï ãïíßäéï ÑÂ1, 6 óôï ÑÂ2, 8 óôï ÑÁ, 17
óôï ÇÁ, 5 óôï ÍÑ, 16 óôï ÍÁ, 5 óôï Ì êáé 10 óôï
NS), ðáñÜ ôçí Ýëëåéøç Üìåóùí ðåéñáìáôéêþí äåäï-
ìÝíùí, ðéóôåýåôáé üôé Ýðáéîáí ñüëï óôçí ðñïóáñ-
ìïãÞ ôïõ óôïí Üíèñùðï.8 Åõôõ÷þò, ìÝ÷ñé ôþñá,
áðïõóéÜæïõí ðïëëïß áðü ôïõò ãåíåôéêïýò äåßêôåò
ðïõ ó÷åôßæïíôáé ìå áõîçìÝíç ìåôáäïôéêüôçôá êáé
ëïéìïãüíï äýíáìç ôïõ éïý óôïí Üíèñùðï - îåíéóôÞ,
÷áñáêôçñéóôéêÜ ðïõ ó÷åôßóôçêáí ìå ôïí éü ôçò éóðá-
íéêÞò ãñßðçò Ç1Í1 ôïõ 1918, êáèþò êáé ìå éäéáßôå-
ñá ðáèïãüíïõò éïýò, üðùò ôçò ãñßðçò ôùí
ðôçíþí.18 ÂÝâáéá, åßíáé ãíùóôü üôé ïé éïß ôçò ãñßðçò
Ý÷ïõí ôçí éêáíüôçôá íá åðéôõã÷Üíïõí ôçí ðåñáéôÝ-
ñù ðñïóáñìïãÞ ôïõò óôïí Üíèñùðï ìå äåõôåñï-
ãåíåßò áíáóõíäõáóìïýò êáé ìåôáëëáãÝò. ÕðÜñ÷åé,
ëïéðüí, ðÜíôá ç ðéèáíüôçôá, Ýóôù êáé ðåñéïñéóìÝíç,
ï íÝïò éüò ï ïðïßïò Ý÷åé ðñïÝëèåé áðü ðïëëáðëïýò
áíáóõíäõáóìïýò, íá áíôáëëÜîåé óôï ìÝëëïí ãåíå-
ôéêü ôïõ õëéêü ìå Üëëïõò õøçëüôåñçò ðáèïãïíéêü-
ôçôáò éïýò ãñßðçò.8
Ôá óçìåñéíÜ ãåíåôéêÜ ÷áñáêôçñéóôéêÜ ôïõ íÝïõ
éïý ãñßðçò Á (Ç1Í1) Ý÷ïõí ùò áðïôÝëåóìá ôç ó÷å-
ôéêÜ ÷áìçëÞ èíçôüôçôá, ÷ùñßò áêüìç áõôÞ íá ìðïñåß
íá åêôéìçèåß ìå áêñßâåéá, üðùò êáé ôç ìåãáëýôåñç
åðßðôùóç ôçò ëïßìùîçò óôçí çëéêéáêÞ ïìÜäá 5-24
åôþí. Ôï ãåãïíüò üôé ôá ðáéäéÜ êáé ïé íÝïé åíÞëéêåò,
óôçí ðáñïýóá ôïõëÜ÷éóôïí öÜóç ôçò ðáíäçìßáò,
íïóïýí áðü ôïí íÝï éü ðéï åýêïëá óå ó÷Ýóç ìå ôïõò
ìåãáëýôåñïõò åíÞëéêåò, åßíáé áðïôÝëåóìá, ôüóï ôïõ
äéáöïñåôéêïý êïéíùíéêïý ôïõò ðñïößë, üóï êáé ôçò
Ýëëåéøçò äéáóôáõñïýìåíçò áíïóßáò, ðïõ ðéèáíÜ
õðÜñ÷åé óôá ìåãáëýôåñçò çëéêßáò Üôïìá ëüãù ëïß-
ìùîçò áðü ðáëáéüôåñïõò Ç1Í1 éïýò.2
Ç åìðåéñßá ôïõ ðáñåëèüíôïò Ý÷åé äåßîåé üôé éïß
ðïõ ðñïêáëïýí ðáíäçìßåò êáôÜ ôçí ðïñåßá åîÝëéîÞò
ôïõò õéïèåôïýí "åðéëïãÝò" ðïõ åõíïïýí ôçí áõîçìÝ-
íç ìåôáäïôéêüôçôá, êÜôé ðïõ åí ìÝñåé åîáóöáëßæåôáé
üôáí áõôïß äåí "óêïôþíïõí" Þ "êáèçëþíïõí" óôï êñå-
âÜôé ôïí îåíéóôÞ ôïõò.19 ÅîÜëëïõ, ôá åîåëéêôéêÜ âÞ-
ìáôá ôïõ éïý "åéóâïëÝá" áêïëïõèïýíôáé ðÜíôá áðü
áíôßññïðç åîåëéêôéêÞ ðñïóáñìïãÞ ôïõ áíïóïðïéç-
ôéêïý ìáò óõóôÞìáôïò, ôï ïðïßï ìå ôç óåéñÜ ôïõ, ìÝ-
óù ôçò öõóéêÞò êáé ôçò ôå÷íçôÞò áíïóïðïßçóçò,
éó÷õñïðïéåßôáé êáé ãßíåôáé ðéï åéäéêü óôçí áíôéìåôþ-
ðéóç ôçò "êñßóçò". ÔÝëïò, ç áõîáíüìåíç óýã÷ñïíç
ãíþóç êáé åìðåéñßá ó÷åôéêÜ ìå ôïõò éïýò ôçò ãñßðçò
èá âïçèÞóïõí óôç äéá÷åßñéóç ôçò ðáñïýóáò ðáíäç- 173
ìßáò ìå ôéò êáôÜ ôï äõíáôüí ëéãüôåñåò áðþëåéåò.

Âéâëéïãñáößá
1. Michaelis M, Doerr HW, Cinatl J Jr. Novel swine-origin influenza A virus in
humans: another pandemic knocking at the door. Med Microbiol Immunol
2009; 198: 175-183.
2. Webby RJ, Webster RG. Emergence of influenza A viruses. Philos Trans R
Soc Lond B Biol Sci 2001; 356: 1817-1828.
3. Van Reeth K, Nicoll A. A human case of swine influenza virus infection in
Europe--implications for human health and research. Euro Surveill 2009; 14,
pii: 19124.
4. Garten RJ, Davis CT, Russell CA, Shu B, Lindstrom S, Balish A, et al. Anti-
genic and genetic characteristics of swine-origin 2009 A (H1N1) influenza
viruses circulating in humans. Science 2009; 325: 197-201.
5. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood
FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, et al. Emergence of
a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;
360: 2605-2615.

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Ã. ÂÑÕÙÍÇ, Á. ÔÓÁÊÑÇÓ

6. Chen J-M, Sun Y-X, Chen J-W, Liu S, Yu J-M, Shen C-J, Sun X-D, Peng D.
Panorama phylogenetic diversity and distribution of type A influenza viruses
based on their six internal gene sequences. Virol J 2009; 6: 137 doi:10.1186/
1743-422X-6-137
7. Shinde V, Bridges CB, Uyeki TM, Shu B, Balish A, Xu X, et al. Triple-reas-
sortant swine influenza A (H1) in humans in the United States, 2005-2009. N
Engl J Med 2009; 360: 2616-2625.
8. Ding Í, Wu Í, Xu Q, Chen K, Zhang C. Molecular evolution of novel swine-
origin A/H1N1 influenza viruses among and before human. Virus Genes 2009;
[Epub ahead of print]
9. Babakir-Mina M, Dimonte S, Perno CF, Ciotti M Origin of the 2009 Mexico
influenza virus: a comparative phylogenetic analysis of the principal external
antigens and matrix protein. Arch Virol 2009; 154: 1349-1352.
10. Olsen CW. The emergence of novel swine influenza viruses in North Ameri-
ca. Virus Res 2002; 85: 199-210.
11. Kothalawala H, Toussaint MJ, Gruys E. An overview of swine influenza. Vet
Q 2006; 28: 46-53.
12. Myers KP, Olsen CW, Gray GC. Cases of swine influenza in humans: a revi-
ew of the literature. Clin Infect Dis 2007; 44:1084-1088.
13. Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program.
Emerg Infect Dis 2006; 12: 29-33.
14. Zhou NN, Senne DA, Landgraf JS, Swenson SL, Erickson G, Rossow K, et
al. Genetic reassortment of avian, swine, and human influenza A viruses in
American pigs. J Virol 1999; 73: 8851-8856.
15. Kingsford C, Nagarajan N, Salzberg SL. 2009 Swine-origin influenza A
(H1N1) resembles previous influenza isolates. PLoS ONE 2009, 4: e6402
16. Chutinimitkul S, Thippamom N, Damrongwatanapokin S, Payungporn S,
Thanawongnuwech R, Amonsin A, et al. Genetic characterization of H1N1,
H1N2 and H3N2 swine influenza virus in Thailand. Arch Virol 2008; 153:
1049-1056.
17. Takemae N, Parchariyanon S, Damrongwatanapokin S, Uchida Y, Rutta-
napumma R, Watanabe C, et al. Genetic diversity of swine influenza viruses
isolated from pigs during 2000 to 2005 in Thailand. Influenza and Other Respi
Viruses 2008; 2: 181-189.
174 18. Chang LY, Shih SR, Shao PL, Huang DT, Huang LM. Novel swine-origin
influenza virus A (H1N1): The first pandemic of the 21st century. J Formos
Med Assoc 2009;108: 526-532.
19. Morens DM, Taubenberger JK, Fauci AS. The persistent legacy of the 1918
influenza virus. N Engl J Med 2009; 361: 225-229.

VOL. 54 • ISSUE 4, July - August 2009

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Áíáóêüðçóç

Áñ÷Ýò êáé ðñÜîç óôçí áðïëýìáíóç êáé áíôéóçøßá óôï ÷þñï

ôïõ íïóïêïìåßïõ

Ð. ÓôáìáôÜêç - Óùôçñïðïýëïõ
Ãñáöåßï Íïóïêïìåéáêþí Ëïéìþîåùí, Íáõôéêü Íïóïêïìåßï Áèçíþí, ÁèÞíá

Ðåñßëçøç
175

ÊÜèå ÷ñüíï óôéò ÇíùìÝíåò Ðïëéôåßåò ôçò ÁìåñéêÞò áñéèìïýíôáé åêáôïììýñéá ÷åéñïõñãåßá êáé Ýíáò
ìåãÜëïò áñéèìüò ðáñåìâáôéêþí äéáäéêáóéþí. ÊÜèå ìßá áðü áõôÝò ôéò éáôñïíïóçëåõôéêÝò äéáäéêá-
óßåò áðáéôïýí ôç ÷ñÞóç éáôñéêþí êáé ÷åéñïõñãéêþí åñãáëåßùí óå, óõíÞèùò, óôåßñåò êïéëüôçôåò ôïõ
áíèñþðéíïõ ïñãáíéóìïý. Ï ìåãÜëïò áñéèìüò áõôþí ôùí éáôñéêþí ðñáêôéêþí åíÝ÷åé êáé ìåãÜëï êßí-
äõíï íïóïêïìåéáêþí ëïéìþîåùí. Ç áíåðéôõ÷Þò äéáäéêáóßá áðïëýìáíóçò êáé áðïóôåßñùóçò ôùí éá-
ôñéêþí åñãáëåßùí óõíåðÜãåôáé ôçí áõîçìÝíç ðéèáíüôçôá ëïßìùîçò áðü ôç ÷ëùñßäá ôïõ áóèåíïýò,
áðü áéìáôïãåíþò ìåôáäéäüìåíá íïóÞìáôá, áëëÜ êáé áðü ðáèïãüíá ôïõ íïóïêïìåéáêïý ðåñéâÜëëï-
íôïò. Ç áðïëýìáíóç êáé ç áðïóôåßñùóç, ùò äéáäéêáóßåò, åëá÷éóôïðïéïýí ôç ìåôÜäïóç ðáèïãüíùí
ìéêñïïñãáíéóìþí óôïõò ÷þñïõò ðáñï÷Þò õãåßáò, åíþ ç áíÜãêç ðïëéôéêÞò ÷ñÞóçò ôïõò, êáôÜ ðå-
ñßðôùóç, èåùñåßôáé åðéâåâëçìÝíç.

Yðåýèõíïò áëëçëïãñáößáò
Ðåôñïýëá ÓôáìáôÜêç-Óùôçñïðïýëïõ
Õðïðëïßáñ÷ïò (ÕÍ)
ÊáóóÜíäñáò 14
ËÝîåéò êëåéäéÜ 13121, ºëéïí
AðïëõìáíôéêÜ, áíôéóçðôéêÜ, ïñéóìïß, ðïëéôéêÞ Ôçë.: 210-2628920, 6974159344
÷ñÞóçò. e-mail: stamatakip@yahoo.gr

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
2-anaskopisi.qxd 14/10/2009 2:32 Page 176
Ð. ÓÔÁÌÁÔÁÊÇ - ÓÙÔÇÑÏÐÏÕËÏÕ
ÅéóáãùãÞ
"Ç áíèñùðüôçôá Ý÷åé ôñåéò ìåãÜëïõò å÷èñïýò: ôïí ðõ-
ñåôü, ôï ëéìü êáé ôïí ðüëåìï. Áðü áõôïýò, ï êõñéüôå-
ñïò êáé ï öïâåñüôåñïò åßíáé ï ðõñåôüò..."
Óåñ William Osler
Ï ÉððïêñÜôçò Þôáí ï ðñþôïò ðïõ ôï 500 ð.×. äßäáóêå
óôïõò ìáèçôÝò ôïõ üôé óôá ôñáýìáôá ðñÝðåé íá ÷ñç-
óéìïðïéåßôáé "âñáóìÝíï íåñü êáé êñáóß", ãéá ôç óýíôï-
ìç êáé áðïôåëåóìáôéêÞ èåñáðåßá ôïõò. Oé ìåëÝôåò ôïõ
Koch êáé ôïõ Pasteur, ðñéí áðü Ýíáí áéþíá, äåß÷íïõí
üôé ç áîéüðéóôç áðïóôåßñùóç ôùí ÷åéñïõñãéêþí åñ-
ãáëåßùí êáé ôùí õðïëïßðùí õëéêþí áðïôåëåß ôï âáóé-
êüôåñï ìÝôñï ãéá ôçí ðñüëçøç ôùí ëïéìþîåùí óôïõò
÷þñïõò ðáñï÷Þò õãåßáò. Óêïðüò ôçò ðáñïýóçò âé-
âëéïãñáöéêÞò áíáóêüðçóçò åßíáé ç åíçìÝñùóç, êá-
èþò êáé ç åõáéóèçôïðïßçóç ôùí Åðáããåëìáôéþí
Õãåßáò óôéò áñ÷Ýò ôùí äéáäéêáóéþí ôçò áðïëýìáíóçò
êáé ôçò áíôéóçøßáò óå ÷þñïõò ðáñï÷Þò õðçñåóéþí
õãåßáò.
Åðéäçìéïëïãßá
Áðü ôçí åðï÷Þ ôïõ Semmelweis ìÝ÷ñé êáé óÞìåñá, ïé
íïóïêïìåéáêÝò ëïéìþîåéò (ÍË) åîáêïëïõèïýí íá áðá-
ó÷ïëïýí ôçí åðéóôçìïíéêÞ êïéíüôçôá, áõîÜíïíôáò ôç
íïóçñüôçôá êáé èíçôüôçôá ôùí áóèåíþí, ìå óçìáíôé-
êÝò áôïìéêÝò, êïéíùíéêÝò, éáôñéêÝò, çèéêÝò êáé ïéêïíï-
ìéêÝò åðéðôþóåéò óå ðñïóùðéêü êáé ðáãêüóìéï
åðßðåäï.1
Ïé ÍË áíáðôýóóïíôáé óôï 5-10% ôùí áóèåíþí ðïõ
åéóÜãïíôáé óôá íïóïêïìåßá. Óôéò ÇíùìÝíåò Ðïëéôåßåò
176
ôçò ÁìåñéêÞò (ÇÐÁ), áñéèìïýíôáé åôçóßùò ðåñßðïõ
1,7 åêáôïììýñéá áóèåíåßò ìå íïóïêïìåéáêÞ ëïßìùîç
(Health care Associated Infections, HAIs), åíþ êáèç-
ìåñéíÜ 247 áóèåíåßò êáôáëÞãïõí, óáí áðïôÝëåóìá
ÍË.2 Óôçí ÅõñùðáúêÞ ¸íùóç, ï åðéðïëáóìüò êáé ç
åðßðôùóç ôçò ÍË áããßæåé ôï 7% êáé 5%, áíôßóôïé÷á.3,4
Óôç ÷þñá ìáò, ç åðéäçìéïëïãéêÞ ìåëÝôç ðïõ äéåíåñ-
ãÞèçêå óå 14 ôñéôïâÜèìéá íïóïêïìåßá Áèçíþí êáé ðå-
ñéöÝñåéáò êáé óôçí ïðïßá ìåëåôÞèçêáí 3.925
áóèåíåßò, Ýäåéîå åðéðïëáóìü ÍË ôçò ôÜîçò ôïõ 9.3%,
ìå ôï õøçëüôåñï ðïóïóôü (13.4%) íá ðáñáôçñåßôáé
óôá ðáíåðéóôçìéáêÜ íïóïêïìåßá êáé ôï ÷áìçëüôåñï
ðïóïóôü (5%) óôá íïóïêïìåßá ôçò ðåñéöÝñåéáò.5
ÅðéóôçìïíéêÝò ìåëÝôåò6,7 äåß÷íïõí ôçí ðáñïõóßá
ôùí ðáèïãüíùí ìéêñïïñãáíéóìþí óå äõíçôéêÜ êáèá-
ñü íïóïêïìåéáêü ðåñéâÜëëïí, üðùò ôá êëéíïóêåðÜ-
óìáôá (40.2%), ôá êñåâÜôéá ôùí áóèåíþí (21-100%),
ôéò ðåñé÷åéñßäåò ðéåóüìåôñùí (88%), ôï ôçëåêïíôñüë
ÔV (75%), ôá ôñáðåæßäéá êëßíçò (22.4-63%), ôá ðüìïëá
ðüñôáò (2.7-38%) êáé ôéò áíôëßåò Ýã÷õóçò áíôéóçðôé-
êþí äéáëõìÜôùí (25%). Óôéò ßäéåò åñåõíçôéêÝò ìåëÝ-
ôåò, áðïìïíþèçêå methicillin-resistant Staphylococcus
aureus (MRSA) áðü ôéò ðáëÜìåò ôùí áóèåíþí óå ðï-
VOL. 54 • ISSUE 4, July - August 2009
óïóôü 29.6%. Áíáíôßññçôá åðïìÝíùò ðáíôïý âñßóêï-
íôáé ìéêñüâéá.6,7
Ç äçìéïõñãßá ðïëéôéêÞò ãéá ôïí Ýëåã÷ï êáé ôçí
ðñüëçøç ôùí ÍË, âáóéæüìåíç óôá óýã÷ñïíá âéâëéï-
ãñáöéêÜ äåäïìÝíá, èåùñåßôáé ðëÝïí åðéôáêôéêÞ áíÜ-
ãêç óå üëåò ôéò ìïíÜäåò ðáñï÷Þò õãåßáò.6,7
ÃëùóóÜñé
Áðïóôåßñùóç: Åßíáé ç ðëÞñçò åîÜëåéøç Þ êáôáóôñï-
öÞ üëùí ôùí åéäþí ìéêñïâéáêÞò æùÞò. Ðñüêåéôáé ãéá
äéáäéêáóßá áõóôçñÜ êáèïñéóìÝíç êáé áðüëõôç ðïõ
ðåñéëáìâÜíåé ôéò âëáóôéêÝò ìïñöÝò ìéêñïâßùí, ôïõò
óðüñïõò êáé ôïõò éïýò. Åðéôõã÷Üíåôáé ôüóï ìå öõóé-
êÜ üóï êáé ìå ÷çìéêÜ ìÝóá (áôìüò õðü ðßåóç, õðåñï-
îåßäéï ôïõ õäñïãüíïõ, îçñÜ èåñìüôçôá 170oC ãéá 2
þñåò, áêôéíïâïëßá ã, ÷çìéêÜ áðïóôåéñùôéêÜ). Ï ðéï
óõ÷íÜ ÷ñçóéìïðïéïýìåíïò êáé óõíÞèùò ðéï áðïôåëå-
óìáôéêüò ôñüðïò áðïóôåßñùóçò åßíáé ç ÷ñÞóç õãñÞò
èåñìüôçôáò õðü ðßåóç, ðïõ åðéôõã÷Üíåôáé ìå ôïõò
õãñïýò êëéâÜíïõò (áõôüêáõóôï). Ç åðéôõ÷ßá ôçò áðï-
óôåéñþóåùò ìå õãñü êëßâáíï åîáñôÜôáé áðü ôïí ôñü-
ðï óõóêåõáóßáò ôïõ õðü áðïóôåßñùóç õëéêïý, ôï
ýøïò ôçò èåñìïêñáóßáò, ôï ÷ñüíï åöáñìïãÞò ôçò
êáé ôçí ðßåóç ðïõ åðéôõã÷Üíåôáé. ÉêáíïðïéçôéêÞ èåù-
ñåßôáé üôáí, óôï ìÝóï ôïõ êýêëïõ áðïóôåßñùóçò, Ý÷åé
åðéôåõ÷èåß ìåßùóç ≥6 log10 cfu ôùí ðëÝïí áíèåêôéêþí
óðüñùí.8,9 Áóçøßá åðéôõã÷Üíåôáé ìüíï ìå ôç äéáäéêá-
óßá ôçò áðïóôåßñùóçò êáé ïñßæåôáé ùò ç äéáäéêáóßá
êáôÜ ôçí ïðïßá, ìå öõóéêÜ Þ ÷çìéêÜ ìÝóá, êáôáóôñÝ-
öïíôáé üëïé ïé ìéêñïïñãáíéóìïß, óõìðåñéëáìâáíïìÝ-
íùí êáé ôùí óðüñùí ôùí ìéêñïâßùí, åíþ ùò Üóçðôç
ôå÷íéêÞ ïñßæåôáé ç ôå÷íéêÞ ìå ôçí ïðïßá ïé åðáããåë-
ìáôßåò õãåßáò ÷åéñßæïíôáé ôá áðïóôåéñùìÝíá áíôéêåß-
ìåíá.8,9
Áðïëýìáíóç: Åßíáé ç åîÜëåéøç Þ ìåßùóç ≥3 log10
cfu ôïõ áñéèìïý ôùí ðáèïãüíùí ìéêñïïñãáíéóìþí,
åêôüò ôùí óðüñùí, áðü áíôéêåßìåíá Þ åðéöÜíåéåò,
þóôå íá ìçí ìðïñïýí íá ðñïêáëÝóïõí ëïßìùîç.8,9
ÉêáíïðïéçôéêÞ èåùñåßôáé ç ìåßùóç ôùí ìéêñïïñãáíé-
óìþí êáôÜ 5 log10 óå 5 min ãéá ôá âáêôÞñéá êáé êáôÜ
4 log10 óå 5 min ãéá ôïõò éïýò. Äéáêñßíåôáé áíÜëïãá ìå
ôï âáèìü ìåßùóçò ôùí ìéêñïïñãáíéóìþí óå õøçëïý,
åíäéÜìåóïõ êáé ÷áìçëïý åðéðÝäïõ áðïëýìáíóç.8,9
Ìå ôçí õøçëïý âáèìïý áðïëýìáíóç (high level di-
sinfection) êáôáóôñÝöïíôáé üëá ôá åßäç ôùí ìéêñïâß-
ùí, åêôüò áðü Ýíá ìåãÜëï áñéèìü óðüñùí. ÁõôÞ
åöáñìüæåôáé óå åñãáëåßá êáé óõóêåõÝò ðïõ Ýñ÷ïíôáé
óå åðáöÞ ìå âëåííïãüíïõò.
Ç åíäéÜìåóïõ âáèìïý áðïëýìáíóçò (intermediate
level disinfection), áäñáíïðïéåß êÜèå âëáóôéêÞ ìïñöÞ
ìéêñïâßùí, ôï ìõêïâáêôçñßäéï ôçò öõìáôéþóåùò (M.
tuberculosis), ôá êïéíÜ ìéêñüâéá (åêôüò ôùí óðüñùí),
ðïëëïýò éïýò êáé ìýêçôåò.
Ç ÷áìçëïý âáèìïý áðïëýìáíóçò (low level disin-
fection) êáôáóôñÝöåé ðïëëÜ êïéíÜ ìéêñüâéá, ìåñéêïýò
2-anaskopisi.qxd 14/10/2009 2:32 Page 177
ÁÑ×ÅÓ ÊÁÉ ??????
?????? ÐÑÁÎÇ ÓÔÇÍ ÁÐÏËÕÌÁÍÓÇ
éïýò êáé ìýêçôåò, åêôüò áðü ôï ìõêïâáêôçñßäéï ôçò
öõìáôéþóåùò êáé ôïõò óðüñïõò ôùí ìéêñïâßùí. Ôá
äéÜöïñá áðïëõìáíôéêÜ, áíÜëïãá ìå ôï âáèìü áðïëý-
ìáíóçò ðïõ åðéôõã÷Üíïõí äéáêñßíïíôáé ìå ôç óåéñÜ
ôïõò óå õøçëïý, åíäéÜìåóïõ êáé ÷áìçëïý âáèìïý
áðïëõìáíôéêÜ (disinfectants).8,9
Áíôéóçøßá æþíôùí éóôþí äÝñìáôïò-÷åñéþí (Anti-
sepsis): Ðñüêåéôáé ãéá ôç äéáäéêáóßá ìå ôçí ïðïßá åðé-
ôõã÷Üíåôáé áðïëýìáíóç ôùí æþíôùí éóôþí Þ ôïõ
äÝñìáôïò ôùí áóèåíþí êáé ìåßùóç Þ áðïìÜêñõíóç
ôçò ðáñïäéêÞò ÷ëùñßäáò ôùí ÷åñéþí ôïõ ðñïóùðéêïý
ìå ðëýóéìï ÷åñéþí (ìåßùóç ≥1 log10 cfu) Þ áíôéóçøßá
÷åñéþí (ìåßùóç ≥4 log10 cfu).10
ÅëÜ÷éóôç áðïôåëåóìáôéêÞ óõãêÝíôñùóç (Mi-
nimum Effective Concentration-MEC) åíüò õãñïý
áðïëõìáíôéêïý åßíáé ç åëÜ÷éóôç óõãêÝíôñùóÞ ôïõ, ìå
ôçí ïðïßá åðéôõã÷Üíåôáé ç ìéêñïâéïêôüíïò äñÜóç ôïõ.
Öáéíüìåíï ðáñÜôáóçò äñÜóçò áðïëõìáíôéêïý
(Postexposure Effect) åßíáé ç éêáíüôçôá ôïõ áðïëõ-
ìáíôéêïý ãéá ðáñÜôáóç áíáóôïëÞò áíÜðôõîçò ôùí ìé-
êñïïñãáíéóìþí êáé ìåôÜ ôï ðÝñáò ôçò åðáöÞò ôïõ
ìå áõôïýò. ×áñáêôçñéóôéêÜ ìðïñåß íá áíáöåñèåß ï
÷ñüíïò äñÜóçò ôçò áëêïüëçò ðïõ åßíáé ìçäåíéêüò,
óå áíôßèåóç ìå ôïí ÷ñüíï äñÜóçò ðñüóèåôùí ïõóéþí
ìå áëêïüëç ðïõ åßíáé ðåñéóóüôåñïò ôùí äýï ùñþí.
Âéïêôüíá Þ ÷çìéêÜ áðïëõìáíôéêÜ - áíôéóçðôéêÜ:
Åßíáé ôá ÷çìéêÜ åêåßíá ðñïúüíôá ðïõ ìåéþíïõí ôïí
áñéèìü Þ áíáóôÝëëïõí ôçí áíÜðôõîç ôùí âëáóôéêþí
ìïñöþí ôùí ìéêñïâßùí. Ï üñïò áíôéóçðôéêÜ ÷ñçóé-
ìïðïéåßôáé ìüíï ãéá ôá áðïëõìáíôéêÜ åêåßíá ðïõ ëü-
ãù Ýëëåéøçò ôïîéêüôçôáò ìðïñåß íá ÷ñçóéìoðïéçèïýí
ãéá ôç ìåßùóç ôïõ áñéèìïý ôùí ìéêñïïñãáíéóìþí óôï
äÝñìá Þ ôïõò äéáöüñïõò éóôïýò.
×çìéêü áðïóôåéñùôéêü (Sterilant): ÏíïìÜæåôáé ôï
÷çìéêü åêåßíï ìÝóï (õøçëïý âáèìïý áðïëõìáíôéêïý)
ìå ôï ïðïßï åðéôõã÷Üíåôáé áðïóôåßñùóç åÜí ðáñáôá-
èåß ï ÷ñüíïò äñÜóçò ôïõ Þ áíÝëèåé ç èåñìïêñáóßá ðÜ-
íù áðü ôïõò 25oC. Ç ÷ñÞóç ôïõ ðåñéïñßæåôáé óôá
èåñìïåõáßóèçôá éáôñéêÜ áíôéêåßìåíá Þ óå åêåßíá üðïõ
åßíáé áäýíáôïí íá áðïóôåéñùèïýí ìå Üëëåò ìåèüäïõò.
Ç äéÜêñéóç ìåôáîý áðïóôåéñùôéêïý Þ áðïëõìáíôé-
êïý äåí åßíáé áðüëõôç, åöüóïí ç éäßá ïõóßá ìðïñåß
íá åßíáé áðïëõìáíôéêü Þ áðïóôåéñùôéêü, áíÜëïãá ìå
ôïí ôñüðï ðïõ ÷ñçóéìïðïéåßôáé.
Êáèáñéóìüò (Cleaning-Decontamination): Äéáäé-
êáóßá êáôÜ ôçí ïðïßá áðïìáêñýíïíôáé îÝíåò ýëåò,
áíüñãáíåò Þ ïñãáíéêÝò, áðü áíôéêåßìåíá Þ åðéöÜíåé-
åò (ìç÷áíéêÜ Þ ìç), ìå áðïôÝëåóìá ôç ìåßùóç ôïõ ìé-
êñïâéáêïý öïñôßïõ. ÓõíçèÝóôáôá óõíäõÜæåôáé ìå ôç
÷ñÞóç áðïëõìáíôéêþí, ãéáôß ôá áðïëõìáíôéêÜ áäñá-
íïðïéïýíôáé ìå ôçí ðáñïõóßá õðïëåéììÜôùí ïñãáíé-
êþí ïõóéþí.8,9
Äéá÷ùñéóìüò êáôÜ Spaulding: Ï Earle H. Spauld-
ing, ðñéí áðü 30 ÷ñüíéá, åéóÞãáãå ôçí êáôçãïñéïðïßç-
óç ôùí áíôéêåéìÝíùí êáé ôïõ éáôñéêïý åîïðëéóìïý
áíÜëïãá ìå ôï âáèìü åðéêéíäõíüôçôáò ãéá áíÜðôõîç
???????? ÊÁÉ ÁÍÔÉÓÇØÉÁ
???? ??????? ÓÔÏ ×ÙÑÏ
???????????? ÔÏÕ ÍÏÓÏÊÏÌÅÉÏÕ
??? Blastocystis sp.
ëïéìþîåùí, ùò õøçëïý, åíäéÜìåóïõ êáé ÷áìçëïý êéí-
äýíïõ êáé, áðü ôï 1985, ôï Centers for Disease Control
and Prevention (CDC), õéïèÝôçóå ôç óõãêåêñéìÝíç
ïñïëïãßá óå áñêåôÝò êáôåõèõíôÞñéåò ïäçãßåò ôïõ.
Áðáñáßôçôç ðñïûðüèåóç åßíáé ôá õëéêÜ ðñéí ôçí åðá-
íá÷ñçóéìïðïßçóÞ ôïõò íá êáèáñßæïíôáé áðü êÜèå åì-
öáíÞ ñýðï ðñéí íá ôïðïèåôçèïýí óôç ÷çìéêÞ ïõóßá
ðñïò áðïëýìáíóç Þ áðïóôåßñùóç (Ðßíáêáò 1).11
Ç äéáäéêáóßá ôçò áðïëýìáíóçò-áðïóôåßñùóçò åß-
íáé áíáìöéóâÞôçôá, ìßá äõíáìéêÞ äéáäéêáóßá. ¸ôóé
íÝá ðåéñáìáôéêÜ äåäïìÝíá ôñïðïðïßçóáí ôéò êáôåõ-
èõíôÞñéåò ïäçãßåò ðïõ åß÷áí åêäïèåß áðü ôï CDC ôï
1981 êáé äéáìüñöùóáí íÝåò, áíÜëïãá ìå ôçí áðïôå-
ëåóìáôéêüôçôá ôùí ÷çìéêþí ïõóéþí.
Áðïëýìáíóç ðáèïãüíùí ðïõ ÷ñÞæïõí
áõîçìÝíçò åðéôÞñçóçò êáé åðåßãïõóáò
áíôéìåôþðéóçò (Emerging Pathogens)
Ãéá åñãáëåßá êáé óõóêåõÝò ðïõ åßíáé åðéìïëõóìÝíåò
ìå áßìá Þ Üëëá âéïëïãéêÜ õãñÜ ðñïåñ÷üìåíá áðü
Üôïìá ðïõ Ý÷ïõí ìïëõíèåß ìå ðáèïãüíá ðïõ ÷ñÞæïõí
áõîçìÝíçò åðéôÞñçóçò, áðáéôåßôáé íá ôçñçèïýí ïé âá-
óéêÝò áñ÷Ýò áðïëýìáíóçò óå üëïõò ôïõò ÷þñïõò ðá-
ñï÷Þò õðçñåóéþí õãåßáò. ÅíäåéêôéêÜ ôùí ðáñáðÜíù
ðáèïãüíùí åßíáé ôá Clostridium difficile, Cryptospori-
dium parvum, Helicobacter pylori, Escherchia coli
Ï157:Ç7 êáé Üëëá (Ðßíáêáò 2).11
Á. Creutzfeldt-Jacob (CJD) – Óðïããþäç åãêåöá-
ëïðÜèåéá êáé éáôñéêÝò óõóêåõÝò. Ôï 1920 ïé Hans
Gerhard Creutzfeldt êáé Alfons Jakob ðåñéÝãñáøáí ãéá
ðñþôç öïñÜ óå áóèåíåßò Üíù ôùí 50 åôþí (ìÝóç çëé-
êßá 67 Ýôç) ìéá ôá÷Ýùò åîåëéóóüìåíç èáíáôçöüñï åê- 177
öõëéóôéêÞ íüóï ôïõ ÊÍÓ, ðïõ ÷áñáêôçñéæüôáí êëéíéêÜ
êõñßùò áðü Üíïéá êáé éóôïëïãéêÜ áðü óðïããþäç åê-
öýëéóç ôïõ åãêåöáëéêïý éóôïý. Ç óõíçèÝóôåñç ìïñ-
öÞ (85-90%) ôçò íüóïõ, ðïõ êáèéåñþèçêå ùò íüóïò
ôùí Creutzfeldt êáé Jakob (Creutzfeldt-Jakob-Disease
CJD), åßíáé ç óðïñáäéêÞ, ç ïðïßá ðáñïõóéÜæåé ðáãêï-
óìßùò óôáèåñÞ åðßðôùóç, êõìáéíüìåíç ìåôáîý 0,5-1
ðåñéóôáôéêü / åêáôïììýñéï ðëçèõóìïý.12 ÐáñáëëáãÞ
ôçò áóèÝíåéáò ôçò óðïããþäïõò åãêåöáëïðÜèåéáò
óôïí Üíèñùðï åßíáé ç ôñïðïðïéçìÝíç ìïñöÞ (vCJD)
ðïõ ðñùôïäéáãíþóôçêå ôï 1996.12
Óýìöùíá ìå ôç èåùñßá ôïõ Stanley Prusiner, ç
ïðïßá êáé ôïõ ÷Üñéóå ôï âñáâåßï Nobel ôï 1997, ïé
óðïããþäåéò åãêåöáëïðÜèåéåò ïöåßëïíôáé óå ìç óõì-
âáôéêïýò ëïéìþäåéò ðáñÜãïíôåò ðïõ áíáðáñÜãïíôáé
÷ùñßò ôç ìåóïëÜâçóç íïõêëåúêÞò ðëçñïöïñßáò (DNA
Þ RNA). Ðñüêåéôáé ãéá ôá ðáóßãíùóôá ðëÝïí prions,
äçëáäÞ ãéá ðñùôåÀíåò áðïôåëïýìåíåò áðü áëõóßäá
253 áìéíïîÝùí ðïõ ÷áñáêôçñßæïíôáé áðü åîáéñåôéêÞ
áíèåêôéêüôçôá êáôÜ ôçí ÝêèåóÞ ôïõò óå éïíßæïõóá
áêôéíïâïëßá êáé ôçí åðåîåñãáóßá ôïõò ìå áëêïïëïý-
÷á äéáëýìáôá. Ôá prions äéáôçñïýí ôç ìïñéáêÞ ôïõò
äïìÞ êáé äåí äéáóðþíôáé áðü Ýíæõìá, üðùò ïé äéÜöï-
ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009
2-anaskopisi.qxd 14/10/2009 2:32 Page 178

Ð. ÓÔÁÌÁÔÁÊÇ - ÓÙÔÇÑÏÐÏÕËÏÕ

Ðßíáêáò 1 Äéáäéêáóßá ÷åéñéóìïý õøçëïý, åíäéÜìåóïõ êáé ÷áìçëïý êéíäýíïõ áíôéêåéìÝíùí.

Áíôéêåßìåíá õøçëïý êéíäýíïõ Áíôéêåßìåíá åíäéÜìåóïõ êéíäýíïõ Áíôéêåßìåíá ÷áìçëïý êéíäýíïõ

ÊáôÜôáîç Áíôéêåßìåíá ðïõ åéóÝñ÷ïíôáé óå óôåßñåò
ðåñéï÷Ýò Þ óôï êõêëïöïñéêü óýóôçìá
Óêïðüò Áðïóôåßñùóç
Åðßðåäï ÊáôáóôñïöÞ üëùí ôùí ìéêñïïñãá-
äñÜóçò íéóìþí, ðåñéëáìâáíïìÝíùí êáé ôùí
óðüñùí ôïõò
ÌÝèïäïò Êëßâáíïò áôìïý, áåñßïõ, õðåñïîåéäßïõ
ôïõ õäñïãüíïõ (hydrogen peroxide
gas plasma), ÷çìéêÞ áðïóôåßñùóç
ÐáñÜäåéãìá ×åéñïõñãéêÜ åñãáëåßá, êáñäéáêïß
êáèåôÞñåò, ïõñïêáèåôÞñåò,
åìöõôåýìáôá
×çìéêÞ Glutaraldehyde (2.0% ≥2.4%)
áðïóôåßñùóç Hydrogen peroxide (7.5%)
Peracetic acid (0.2%)+
hydrogen peroxide (1.0%)
Peracetic acid (0.08%)+
hydrogen peroxide (7.35%)
Peracetic acid (0.23%)
Glutaraldehyde (1,12%) +
phenol/phenate (1,93%)
Glutaraldehyde (0.95%) +
phenol/phenate (1.64%)
Áíôéêåßìåíá ðïõ Ýñ÷ïíôáé óå åðáöÞ
ìå âëåííïãüíïõò êáé ìç áêÝñáéï äÝñìá
Åëåýèåñá áðü üëïõò ôïõò ìéêñïïñãáíé-
óìïýò, åêôüò ìåãÜëïõ áñéèìïý
âáêôçñéáêþí óðüñùí
ÊáôáóôñïöÞ üëùí ôùí ìéêñïïñãáíé-
óìþí, åêôüò âáêôçñéáêþí óðüñùí
Õøçëïý âáèìïý áðïëýìáíóç
Åíäïóêüðéá, åîïðëéóìüò áíáðíåõóôéêÞò
èåñáðåßáò, åîïðëéóìüò áíáéóèçóßáò,
ôïíüìåôñá
Glutaraldehyde >2.0%
Ortho-phthalaldehyde (12 min) 0.55%
Hydrogen peroxide 7.5%
Hydrogen peroxide + peracetic acid
1.0% + 0.08%
Hydrogen peroxide 7.5% +
peracetic acid 0.23%
Hypochlorite (free chlorine)
650-675 ppm. 55%
Áíôéêåßìåíá ðïõ Ýñ÷ïíôáé óå åðáöÞ
ìå âëåííïãüíïõò Þ áêÝñáéï äÝñìá
ÁíáìÝíåôáé íá öÝñïõí êÜðïéïõò
ìéêñïïñãáíéóìïýò
ÊáôáóôñïöÞ ôùí âëáóôéêþí ìïñöþí
ôùí âáêôçñßùí, ìõêÞôùí, ëéðüöéëùí
éþí
×áìçëïý âáèìïý áðïëýìáíóç, ðñï-
çãåßôáé ç áðïññýðáíóç ôïõ õëéêïý
Åíáíôßïí: Listeria, Escherichia coli,
Salmonella, MRSA, VRE (30-60 min)
¢øõ÷ï íïóïêïìåéáêü ðåñéâÜëëïí,
åîïðëéóìüò, ðåñé÷åéñßäåò ðéåóïìÝ-
ôñùí, çëåêôñüäéá ÇÊÃ, äÜðåäá êëð.
Ethyl Þ isopropylalcohol 70-90%
Chlorine 100 ppm (1:500)
Phenolic
Iodophor
Quaternary ammonium

ñåò ðñïôåÜóåò êáé íïõêëåÜóåò, êáé ãé’ áõôü ôï ëüãï ùò áðïôÝëåóìá éáôñïãåíïýò ìåôÜäïóçò CJD ìåôÜ ôç
178
ðáñïõóéÜæïõí áíôï÷Þ óôéò êëáóéêÝò ìåèüäïõò áðï- ÷ñÞóç ìïëõóìÝíïõ éáôñéêïý åîïðëéóìïý êáôÜ ôç
ëýìáíóçò.12 äéÜñêåéá åðåìâáôéêÞò äéáäéêáóßáò.13 Ðáñüë’ áõôÜ, ç
Óå ðïóïóôü ìéêñüôåñï áðü 1% ç CJD ó÷åôßæåôáé áðïôåëåóìáôéêüôåñç äéá÷åßñéóç ôùí éáôñéêþí åñãá-
ìå ìåôÜäïóç ìÝóù éáôñïíïóçëåõôéêïý ðñïóùðéêïý ëåßùí ðïõ Ý÷ïõí Ýñèåé óå åðáöÞ ìå åãêÝöáëï, íù-
êáé ìüíï Ýíá åðéâåâáéùìÝíï êñïýóìá Ý÷åé áíáöåñèåß ôéáßï ìõåëü êáé éóôïýò ôïõ ïöèáëìïý áóèåíþí áðü
ôç íüóï CJD Þ ôùí áôüìùí ìå õðïøßá CJD, ðñÝðåé íá
áðïôåöñþíïíôáé. ¼ðïõ äýíáôáé, ç ÷ñçóéìïðïßçóç éá-
Ðáèïãüíá ðïõ ÷ñÞæïõí áõîçìÝíç åðéôÞñçóç êáé ôñéêþí åñãáëåßùí ìéáò ÷ñÞóçò áðïôåëåß ôçí êáëýôå-
Ðßíáêáò 2 åðåßãïõóá áíôéìåôþðéóç (Emerging Pathogens).
ñç åðéëïãÞ ãéá ôçí áóöÜëåéá ôïõ õãåéïíïìéêïý
Éüò çðáôßôéäáò B (HBV) ðñïóùðéêïý.
Éüò çðáôßôéäáò C (HCV) Óå ðåñßðôùóç ðïõ äåí åßíáé åöéêôÞ ç êáôáóôñïöÞ
Éüò áíèñþðéíçò áíïóïëïãéêÞò áíåðÜñêåéáò (HIV) ôùí åñãáëåßùí ðïëëáðëþí ÷ñÞóåùí, ôá ðñïôåéíüìå-
Mycobacterium tuberculosis íá ìÝôñá ãéá ôçí áðïóôåßñùóç ôùí ÷åéñïõñãéêþí åñ-
Clostridium difficile ãáëåßùí Þ ôùí éáôñéêþí óõóêåõþí, åöüóïí õðÜñ÷åé ç
Cryptosporidium parvum äéáâåâáßùóç áðü ôïí êáôáóêåõáóôÞ üôé ôá åñãáëåßá
Helicobacter pylori áõôÜ õðü ôéò óõãêåêñéìÝíåò óõíèÞêåò äåí êáôáóôñÝ-
E. coli O157:Ç7 öïíôáé, åßíáé ôá áêüëïõèá:
Rotavirus
1. Âýèéóìá óå äéÜëõìá 1N NaOH: äéÜëõìá 40g Na-
Nontuberculosis mycobacteria (ð.÷. M. chelonae)
OH óå 1L íåñü) ãéá ìßá þñá, îÝâãáëìá êáé áðï-
ÐïëõáíèåêôéêÜ (VRE, MRSA, MDR-TB)
SARS – ó÷åôéæüìåíïé coronaviruses óôåßñùóç óôïõò 121ïC óå êëßâáíï âáñýôçôáò Þ
Éüò ôçò ãñßðçò ôùí ðôçíþí óôïõò 134ïC óå êëßâáíï êåíïý ãéá ìßá þñá.
Ðáèïãüíá âéïôñïìïêñáôßáò (Üíèñáêáò, ðáíþëç, åõëïãéÜ) 2. Âýèéóìá óå äéÜëõìá 1N NaOH ãéá ìßá þñá, îÝ-
âãáëìá êáé áðïóôåßñùóç óôïõò 121ïC óå êëßâá-

VOL. 54 • ISSUE 4, July - August 2009

2-anaskopisi.qxd 14/10/2009 2:32 Page 179

ÁÑ×ÅÓ ÊÁÉ ??????

?????? ÐÑÁÎÇ ÓÔÇÍ ÁÐÏËÕÌÁÍÓÇ
???????? ÊÁÉ ÁÍÔÉÓÇØÉÁ
???? ??????? ÓÔÏ ×ÙÑÏ
???????????? ÔÏÕ ÍÏÓÏÊÏÌÅÉÏÕ
??? Blastocystis sp.

íï âáñýôçôáò ãéá 30 min êáé áêïëïõèåß ç óõìâá- Åðßðåäï ìïëõóìáôéêüôçôáò - åðéêéíäõíüôçôáò éóôþí /
ôéêÞ áðïóôåßñùóç ñïõôßíáò. âéïëïãéêþí õãñþí áðü áóèåíåßò ãíùóôïýò Þ õðü-
Ðßíáêáò 3 ðôïõò ãéá íüóï ïöåéëüìåíç óå prion.
3. Âýèéóìá óå äéÜëõìá 1N NaOH ãéá ìßá þñá, îÝ-
âãáëìá êáé áðïóôåßñùóç óôïõò 134ïC ãéá 28 min ÕøçëÞò ×áìçëÞò
óå êëßâáíï êåíïý Þ óôïõò 132ïC ãéá ìßá þñá óå åðéêéíäõíüôçôáò åðéêéíäõíüôçôáò
êëßâáíï âáñýôçôáò. éóôïß, âéïëïãéêÜ éóôïß, âéïëïãéêÜ Áêßíäõíïé éóôïß,
õãñÜ õãñÜ âéïëïãéêÜ õãñÜ
Åßíáé áðáñáßôçôï ôá åñãáëåßá áõôÜ íá äéáôçñïý-
Åãêåöáëéêüò Åãêåöáëïíùôéáßï ÐåñéöåñéêÜ
íôáé õãñÜ (íá âõèßæïíôáé óå õãñü), ìÝ÷ñé íá êáèáñé-
éóôüò õãñü íåýñá
óôïýí, ãéá íá áðïöåõ÷èåß ç áðïîÞñáíóç ôùí éóôþí ÓêëçñÜ ìÞíéããá ¹ðáñ ¸íôåñï
êáé ôùí óùìáôéêþí õãñþí. Åðßóçò äåí ðñÝðåé íá ÷ñç- Íùôéáßïò ìõåëüò ËåìöáäÝíåò Ìõåëüò ôùí ïóôþí
óéìïðïéåßôáé ç ôá÷åßá áðïóôåßñùóç, åíþ áíôéêåßìåíá ÌÜôéá Íåöñïß Ïëéêü áßìá
ðïõ åðéäÝ÷ïíôáé ìüíï øõ÷ñÞ áðïóôåßñùóç (ð.÷. óå Ðíåýìïíåò Ëåõêïêýôôáñá
êëßâáíï áåñßïõ Þ ðëÜóìáôïò) ðñÝðåé íá åßíáé ìéáò ÓðëÞíáò Ïñüò
÷ñÞóçò.14 Ðëáêïýíôáò ÈõñåïåéäÞò áäÝíáò
Ïé åðéöÜíåéåò ôïõ ðåñéâÜëëïíôïò êáé ï åîïðëé- Åðéíåöñßäéá
óìüò ÷áìçëïý êéíäýíïõ, üðùò äÜðåäá, ðïõ åßíáé ìï- ÊáñäéÜ
ëõóìÝíá ìå õøçëïý êéíäýíïõ éóôïýò, ðñÝðåé íá ÐñïóôÜôçò
¼ñ÷åéò
êáèáñßæïíôáé êáé åí óõíå÷åßá íá áðïëõìáßíïíôáé ìå
Óêåëåôéêïß ìýåò
äéÜëõìá õðï÷ëùñéþäïõò íáôñßïõ 1:10 Þ ìå 1 N NaOH
Ëéðþäçò éóôüò
1 ìå 2 þñåò (Ðßíáêáò 3).11,15,16,17 Óõíäåôéêüò éóôüò
Ôá ìÝóïõ Þ õøçëïý êéíäýíïõ éáôñéêÜ åñãáëåßá, ÄÜêñõá
ðïõ ÷ñçóéìïðïéÞèçêáí óå éóôïýò ÷áìçëïý êéíäýíïõ Ñéíéêüò âëåííïãüíïò
ðñïåñ÷üìåíïé áðü áóèåíÞ õøçëïý êéíäýíïõ, ðñÝðåé Áðåêêñßóåéò
ðñþôá íá ðëõèïýí êáé åí óõíå÷åßá íá áðïóôåéñùèïýí (ïýñá, êüðñáíá)
ìå ôéò óõìâáôéêÝò óõíèÞêåò áðïóôåßñùóçò (èåñìü- ÓðÝñìá,
ôçôá, øõ÷ñÞ áðïóôåßñùóç) Þ íá õðïóôïýí õøçëïý ÊïëðéêÝò åêêñßóåéò
âáèìïý áðïëýìáíóç. ÃÜëá
Ïé åðéöÜíåéåò ðïõ Ý÷ïõí ìïëõíèåß ìå éóôïýò ôçò
ßäéáò êáôçãïñßáò, áðáéôïýí ìüíï ôç óõíÞèç áðïëý-
ìáíóç. Ç ßäéá äéáäéêáóßá åöáñìüæåôáé êáé ãéá ôá ìÝ- 20ïC, óõãêÝíôñùóç õðåñïîéêïý ïîÝïò Þ ðáñáïîéêïý
óïõ Þ õøçëïý êéíäýíïõ éáôñéêÜ åñãáëåßá ðïõ Ý÷ïõí ïîÝïò ìåãáëýôåñç ôùí 0,2%, ðïõ áäñáíïðïéåß ðåñéó-
÷ñçóéìïðïéçèåß óå áêßíäõíïõò éóôïýò ðñïåñ÷üìå- óüôåñï áðü 104 ìéêñïâéáêü öïñôßï óå 10-12 min 179
íïõò áðü áóèåíÞ õøçëïý êéíäýíïõ. Ïé åðéöÜíåéåò ôïõ óôïõò 20ïC, åðéôõã÷Üíïõí õøçëïý âáèìïý áðïëýìáí-
ðåñéâÜëëïíôïò ðïõ Ý÷ïõí ìïëõíèåß ìå áêßíäõíïõò óç. Ç ÷ñÞóç õðï÷ëùñéþäïõò äéáëýìáôïò óõãêÝíôñù-
éóôïýò áðáéôïýí ôç óõíÞèç áðïëýìáíóç ãéá áäñáíï- óçò 1,600 ppm Ý÷åé áðïôåëåóìáôéêÞ áðïëõìáíôéêÞ
ðïßçóç ðáèïãüíùí ðïõ ìåôáäßäïíôáé áéìáôïãåíþò.9 äñÜóç ãéá åðéöÜíåéåò óå áóèåíåßò ìå äéáññïúêÝò êå-
Â. Óðüñïé Clostridium difficile. Ôï Clostridium dif- íþóåéò Þ êïëßôéäåò ðïõ ó÷åôßæïíôáé ìå ôï C. difficile. Ç
ficile åßíáé Ýíáò Gram - èåôéêüò óðïñïãüíïò âÜêéëëïò, ÷ñÞóç ôïõ ðáñáðÜíù äéáëýìáôïò ìå óõãêÝíôñùóç
ðïõ ðåñéãñÜöçêå ðñþôç öïñÜ óáí ôìÞìá ôçò åíôåñé- 5,000 ppm, ìåéþíåé ôï ìéêñïâéáêü öïñôßï êáôÜ 106 C.
êÞò ÷ëùñßäáò íåïãíþí ôï 1935 (the difficult clostri- difficile, óå ëéãüôåñï áðü 10 min.18
dium). Óõó÷åôßóôçêå ìå øåõäïìåìâñáíþäç êïëßôéäá Ã. Áðïëýìáíóç Coronavirus - SARS. Ïé coro-
ôç äåêáåôßá ôïõ '70 êáé áñãüôåñá ìå ôéò åêäçëþóåéò naviruses åßíáé ìÝëç ìéáò ïéêïãÝíåéáò RNA éþí ìåãÜ-
ôçò êëùóôçñéäéáêÞò íüóïõ (CDAD, Clostridium diffici- ëïõ ìåãÝèïõò. Ôï RNA ôùí éþí áõôþí åßíáé ìïíÞò
le associated disease). Áðïôåëåß ôï óõ÷íüôåñï áßôéï Ýëéêáò êáé èåôéêÞò êáôåýèõíóçò. ÄéáèÝôïõí åîùôåñé-
äéÜññïéáò áðü áíôéâéïôéêÜ (15-25%) êáé ôï êõñéüôåñï êü ðåñßâëçìá (envelope) êáé ðïëëáðëáóéÜæïíôáé óôï
óðïñïãüíï âáêôÞñéï ðïõ ðñïêáëåß ÍË.18 Õðïëïãßæå- êõôôáñüðëáóìá ôïõ êõôôÜñïõ îåíéóôÞ. Åíï÷ïðïéïý-
ôáé üôé ôï 15-55% ôïõ óõíüëïõ ôùí ðåñéðôþóåùí íï- íôáé ãéá ôï 1/3 ôùí êïéíþí êñõïëïãçìÜôùí, êáé åðé-
óïêïìåéáêÞò äéÜññïéáò ðñïêáëïýíôáé áðü C. difficile. âéþíïõí óôéò åðéöÜíåéåò ãéá þñåò. Ï íÝïò éüò
ÊáôÜ ìÝóï üñï, ïé áóèåíåßò ìå äéÜññïéá áðü C. diffi- SARS-CoV (áßôéï ôïõ óïâáñïý ïîÝïò áíáðíåõóôéêïý
cile ðáñáôåßíïõí ôçí ðáñáìïíÞ ôïõò óôï íïóïêïìåßï óõíäñüìïõ) áíÞêåé óå ìßá ôÝôáñôç êáôçãïñßá êïñï-
3,6 çìÝñåò åî áéôßáò ôçò ÍË. ÁõôÞ ç ðáñÜôáóç ôçò íáúþí, üðïõ ç áíÜëõóç ôçò áëëçëïõ÷ßáò ôïõ ãïíéäéþ-
íïóçëåßáò óôéò ÇÐÁ Ý÷åé Ýíá ïéêïíïìéêü êüóôïò $ ìáôüò ôïõ åðéâåâáéþíåé ôçí õðüèåóç üôé ðñüêåéôáé ãéá
3,669, áíÜ ðåñßðôùóç. éü ôùí æþùí ôïõ ïðïßïõ ï öõóéêüò îåíéóôÞò åßíáé áêü-
Ç ÷ñÞóç óêåõáóìÜôùí, üðùò 2% ãëïõôáñáëäåýäç ìá Üãíùóôïò.19
(5-20 min), 0.55% ïñèïöèáëäåýäç (10-12 min) óôïõò Ãéá ôïí éü SARS-CoV, éùäïöüñá ðñïúüíôá (1% io-

ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009

2-anaskopisi.qxd 14/10/2009 2:32 Page 180
Ð. ÓÔÁÌÁÔÁÊÇ - ÓÙÔÇÑÏÐÏÕËÏÕ
dine) óå 1 min, áéèõëéêÞ áëêïüëç 70% ãéá 2 min, ïé-
êéáêÞ ÷ëùñßíç 1:100 óå ÷áìçëïý êéíäýíïõ áíôéêåßìåíá,
0.5% ãëïõôáñáëäåàäç ãéá 2 min, 2,5% ãëïõôáñáëäåû-
äç ãéá 5 min (ìßá ìåëÝôç äåß÷íåé ðëÞñç áäñáíïðïßçóç)
èåùñïýíôáé áðïôåëåóìáôéêÜ ãéá áðïëýìáíóç, áíôéóç-
øßá êáé õøçëïý åðéðÝäïõ áðïëýìáíóç, áíôßóôïé÷á.
Áðïóôåßñùóç Þ õøçëïý âáèìïý áðïëýìáíóç äåí
áðáéôåßôáé óå õøçëïý êáé åíäéÜìåóïõ êéíäýíïõ áíôé-
êåßìåíá êáôÜ Spaulding.11
Ïé ëïéðïß coronaviruses åßíáé åõáßóèçôïé óå éùäï-
öüñá ðñïúüíôá, õäáôéêÜ äéáëýìáôá áëêïüëçò 60-
90%, ãëïõôáñáëäåàäç, ïñèïöèáëäåàäç, ïéêéáêÞ
÷ëùñßíç ìå äéÜëõóç 1:10, åíþ ðáñïõóéÜæïõí áíèåêôé-
êüôçôá óå öáéíüëåò, ôåôáñôïôáãÞ Üëáôá áììùíßïõ
êáé éóïðñïðõëéêÞ áëêïüëç 70%.8
ÊñéôÞñéá åðéëïãÞò áðïëõìáíôéêþí -
áíôéóçðôéêþí
Ç åðéëïãÞ ôçò áðïëõìáíôéêÞò äéáäéêáóßáò óôçí êá-
èçìåñéíÞ ðñáêôéêÞ ôùí ÷þñùí õðçñåóéþí õãåßáò
åîáñôÜôáé áðü ôï åßäïò êáé ôç óõ÷íüôçôá ôïõ ìéêñï-
ïñãáíéóìïý, ôç ìéêñïâéáêÞ áíôï÷Þ, åÜí ôá åñãáëåßá
åßíáé õøçëïý, åíäéÜìåóïõ êáé ÷áìçëïý êéíäýíïõ, ôéò
óõíèÞêåò ðåñéâÜëëïíôïò (èåñìïêñáóßá, pH, ïñãáíé-
êü õëéêü) êáé ôï "Decimal reduction time" Þ "D value",
äçëáäÞ ôï ÷ñüíï ðïõ áðáéôåßôáé ãéá íá êáôáóôñáöåß
ôï 90% ôïõ ìéêñïâéáêïý ðëçèõóìïý.
Ïé ðñïáðáéôïýìåíåò Üäåéåò óýìöùíá ìå ôï íïìï-
èåôéêü ðëáßóéï êõêëïöïñßáò áðïëõìáíôéêþí, áðïññõ-
ðáíôéêþí ðïõ óõíïäåýïõí ôçí åêÜóôïôå ÷çìéêÞ ïõóßá
åßíáé ïé ðáñáêÜôù:
• ãéá ôá áðïëõìáíôéêÜ ÷åéñïõñãéêþí åñãáëåßùí êáé
180
åíäïóêïðßùí ôï óÞìá “CE” (CE mark)
• ãéá áðïëõìáíôéêÜ ìå êáèáñéóôéêÝò éäéüôçôåò ÷åé-
ñïõñãéêþí åñãáëåßùí êáé åíäïóêïðßùí ôá CE mark
êáé Ãåíéêü ×çìåßï ôïõ ÊñÜôïõò (Ã×Ê).
• ãéá áðïëõìáíôéêÜ åðéöáíåéþí ç Üäåéá áðü ôïí
ÅÏÖ.
• ãéá áðïëõìáíôéêÜ ìå êáèáñéóôéêÝò éäéüôçôåò êáé
åðéöáíåéþí ç Üäåéá áðü ÅÏÖ êáé Ã×Ê.
• ãéá áðïññõðáíôéêÜ ÷åéñïõñãéêþí åñãáëåßùí êáé
åíäïóêïðßùí ôá CE mark êáé Ã×Ê êáé, âÝâáéá,
• ãéá üëåò ôéò åôáéñåßåò äéáêßíçóçò áðïëõìáíôéêþí
ç ðéóôïðïßçóç ðïéüôçôáò (International Standards’
Organisation, ISO), ç ïðïßá áðïôåëåß "Ýêöñáóç"
áîéïðéóôßáò ôïõ ðñïúüíôïò.
Åðßóçò, ç áðïôåëåóìáôéêüôçôá áðïëõìáíôéêþí
êáé áðïññõðáíôéêþí ïõóéþí äéáóöáëßæåôáé áðü ôéò
êáôåõèõíôÞñéåò ïäçãßåò üðùò Ý÷ïõí äéáìïñöùèåß
áðü áíáãíùñéóìÝíïõò êñáôéêïýò ïñãáíéóìïýò (åõ-
ñùðáúêïýò, áìåñéêÜíéêïõò êëð.), ôá ðéóôïðïéçôéêÜ
óõìâáôüôçôáò ìå ôá õëéêÜ êáé ôïí åîïðëéóìü ðïõ
ðñüêåéôáé íá ÷ñçóéìïðïéçèïýí, ôá äåëôßá äåäïìÝ-
íùí áóöÜëåéáò ðñïúüíôùí (Material Safety Data
VOL. 54 • ISSUE 4, July - August 2009
Sheet), ôçí ðñïçãïýìåíç åìðåéñßá, ôá ðñùôüêïëëá
åëÝã÷ïõ êáé ôéò êëéíéêÝò ìåëÝôåò áðïôåëåóìáôéêüôç-
ôáò êáé áóöÜëåéáò ðïõ óõíïäåýïõí ôï åìðïñéêü
óêåýáóìá.
Ôï óýíïëï ôùí áðïëõìáíôéêþí óêåõáóìÜôùí äåí
åëÝã÷ïíôáé ðÜíôá ìå ôïí ßäéï ôñüðï. Ôá êýñéá ðñùôü-
êïëëá åëÝã÷ïõ ðïõ åðéêñáôïýí óôï ÷þñï ôùí áðïëõ-
ìáíôéêþí åßíáé:
• ãåñìáíéêü ðñùôüêïëëï (Deutsche Gesellschaft fur
Hygiene und Mikrobiologie, DGHM)
• ãáëëéêü ðñùôüêïëëï (Association Francaise de
Normalisation, AFNOR)
• áìåñéêáíéêü ðñùôüêïëëï (Association of Official
analytical Chemists, AOAC)
Åýëïãá, åðïìÝíùò, áíôéëáìâáíüìáóôå üôé Ýíá ðéï
áõóôçñü ðñùôüêïëëï åßíáé ðéï áîéüðéóôï êáé ðéï
áóöáëÝò. Ç ÅõñùðáúêÞ ÅðéôñïðÞ, ãéá ôçí áîéïëüãç-
óç ôùí áðïëõìáíôéêþí, ðñüôåéíå ôï 1970 óôï Áì-
âïýñãï ôéò ðáñáêÜôù ìåèüäïõò êáé ôñüðïõò åëÝã÷ïõ
ôùí áðïëõìáíôéêþí:
• in vitro (óå åñãáóôçñéáêÝò éäåþäåéò óõíèÞêåò)
• in practice (óå óõíèÞêåò ðáñüìïéåò ôùí ðñáãìá-
ôéêþí)
Ïé "in vitro" ìÝèïäïé äéáêñßíïíôáé óå:
– ìÝèïäïò åíáéþñçóçò (suspension test): êáôÜ ôç
ìÝèïäï áõôÞ áíáìéãíýïíôáé êáëëéåñãÞìáôá êáë-
ëéåñãåéþí ìå äéáëýìáôá áðïëõìáíôéêþí, óå êáèï-
ñéóìÝíï ÷ñüíï êáé áíáêáëëéåñãïýíôáé ðïóüôçôåò
áðü ôá äåßãìáôá ãéá íá äéáðéóôùèåß êáôÜ ðüóï åðé-
ôõã÷Üíåôáé áíáóôïëÞ áíÜðôõîçò).
– ìÝèïäïò åðß äéáöüñùí õëéêþí öïñÝùí (carrier
test): ìåãÜëïò áñéèìüò öïñÝùí, üðùò ôìÞìáôá
õöÜóìáôïò, âõèßæïíôáé óå ìéêñïâéáêÜ åíáéùñÞìá-
ôá, êáé óôç óõíÝ÷åéá Ýñ÷ïíôáé óå åðáöÞ ìå äéáöï-
ñåôéêÝò áñáéþóåéò áðïëõìáíôéêïý, óôïí ßäéï
÷ñüíï, åíþ ôÝëïò åðùÜæïíôáé óå êáëëéÝñãåéåò ìé-
êñïâßùí üðïõ êáôáãñÜöåôáé ç áíÜðôõîç ìéêñï-
ïñãáíéóìþí).
– ìÝèïäïò éêáíüôçôáò äñÜóçò (capacity test): ç ìÝ-
èïäïò áõôÞ ÷ñçóéìïðïéåßôáé óðÜíéá ëüãù ôçò
áóõìâáôüôçôáò ìå äéÜöïñá áðïëõìáíôéêÜ êáé ôçò
ðñïóïìïßùóÞò ôçò ìå ôç ìÝèïäï åíáéþñçóçò.
Ïé ìÝèïäïé ðïõ ÷ñçóéìïðïéïýíôáé åõñýôåñá óÞìå-
ñá åßíáé ç ìÝèïäïò åíáéþñçóçò êáé ç ìÝèïäïò åðß äéá-
öüñùí õëéêþí öïñÝùí, êáèþò êáé ç "in practice"
ìÝèïäïò. Éêáíïðïéçôéêü üñéï âáêôçñéïêôüíïõ éêáíü-
ôçôáò ôïõ áðïëõìáíôéêïý ïñßæåôáé ìßá ìåßùóç ôùí ìé-
êñïâßùí ôçò ôÜîçò ôùí ðÝíôå ëïãáñéèìéêþí åðéðÝäùí
(5 log10) óå 5 min. Áîéïëïãþíôáò ôá ðñùôüêïëëá åëÝã-
÷ïõ ôùí áðïëõìáíôéêþí óêåõáóìÜôùí, ôï ãåñìáíéêü
ðñùôüêïëëï DGHM åìöáíßæåôáé ùò ôï ðëçñÝóôåñï
êáé ðëÝïí áõóôçñü, ðåñéëáìâÜíïíôáò ôáõôü÷ñïíá ôéò
ìåèüäïõò åíáéþñçóçò, öïñÝá êáé ðñáãìáôéêþí óõí-
èçêþí.9
2-anaskopisi.qxd 14/10/2009 2:32 Page 181

ÁÑ×ÅÓ ÊÁÉ ??????

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???????????? ÔÏÕ ÍÏÓÏÊÏÌÅÉÏÕ
??? Blastocystis sp.

ÊñéôÞñéá åðéëïãÞò áíôéóçðôéêþí • åõêïëßá ÷ñÞóçò

Ðáñüëï ðïõ Ý÷ïõí êáôáãñáöåß áñêåôÝò ëåðôïìÝ-
ñåéåò ãéá ôá ÷áñáêôçñéóôéêÜ ôùí áíôéóçðôéêþí, ïäçãß-
åò ó÷åôéêÜ ìå ôï ðéï óõãêåêñéìÝíï áíôéóçðôéêü èá
ðñÝðåé íá ÷ñçóéìïðïéçèåß ãéá êÜèå äéáäéêáóßá äåí
õðÜñ÷ïõí ìå áðüëõôç óáöÞíåéá êáé áõôü ïöåßëåôáé
óôï üôé êáíÝíá áíôéóçðôéêü äåí åßíáé éäáíéêü. Ãéá ôçí
åðéëïãÞ ôïõ êáôáëëçëüôåñïõ áíôéóçðôéêïý êáôÜ ðåñß-
ðôùóç, èá ðñÝðåé íá óõíõðïëïãéóôïýí ïé ðáñáêÜôù
ðáñÜãïíôåò:9
• êáôÜóôáóç ôïõ äÝñìáôïò (ãéá áíôéóçðôéêÜ ÷å-
ñéþí)
• èÝóç ôçò ÷åéñïõñãéêÞò åðÝìâáóçò
• áíáìåíüìåíï áñéèìü êáé åßäïò ìéêñïâßùí óôç óõ-
ãêåêñéìÝíç èÝóç
• áóöÜëåéá
• áíôéìéêñïâéáêü öÜóìá
• ôïîéêüôçôá
• êüóôïò - üöåëïò (Cost-effective)
• ôá÷ýôçôá äñÜóçò
• õðïëåéðüìåíç äñÜóç (ãéá áíôéóçðôéêÜ ÷åñéþí).
ÓõìðåñáóìáôéêÜ, ç ðñüëçøç êáé ï Ýëåã÷ïò ôùí
ÍË ðñïâëçìáôßæåé ãéá ÷ñüíéá ôçí åðéóôçìïíéêÞ êïé-
íüôçôá. Ç áõîçìÝíç íïóçñüôçôá êáé èíçôüôçôá ôùí
áóèåíþí, áëëÜ êáé ç ðïëõáíôï÷Þ ôùí ìéêñïâßùí
óôïõò ÷þñïõò ðáñï÷Þò õãåßáò ôçò ÷þñáò ìáò, äç-
ìéïõñãïýí ôçí åðéôáêôéêÞ áíÜãêç ãéá ó÷åäéáóìü ðï-
ëéôéêÞò ÷ñÞóçò áðïëõìáíôéêþí êáé áíôéóçðôéêþí
óôá åëëçíéêÜ íïóïêïìåßá. Ç ìåèïäéêüôçôá êáé
åöáñìïãÞ ôçò éáôñéêÞò êáé íïóçëåõôéêÞò åðéóôÞìçò
âáóéóìÝíç óå åíäåßîåéò êáé óå ìéá äõíáìéêÞ äéáäé-
êáóßá, üðùò åßíáé ôçò áðïëýìáíóçò êáé ôçò áíôéóç-
øßáò, ìðïñïýí íá óõìâÜëïõí áíáíôßññçôá óôçí
ðñüëçøç, áëëÜ êáé óôç ìåßùóç ôùí ÍË óå áñêåôÜ
éêáíïðïéçôéêü åðßðåäï.

Summary

181
Principles and policies for appropriate use of disinfectants
and antiseptics in health care facilities

P. Stamataki - Sotiropoulou
Infection Control Department, Naval Hospital of Athens, Athens, Greece

Each year, in the United States millions surgical procedures and a great number of invasive medical
procedures occur. Every procedure involves direct contact by a medical device or surgical instrument
with the patient's sterile tissues or mucous membranes. Thus a major risk of the invasive medical pro-
cedures is the initiation of infections. Failure to disinfect or sterilize properly the necessary surgical
equipment, carries the risk of transmission of environmental pathogens (e.g. Pseudomonas aerugi-
nosa) in addition to person-to-person transmission of pathogens (e.g. hepatitis B virus) The acco-
mplishment of proper disinfection and sterilization conditions through the use of the right disinfectants
and sterilization practices can guarantee that the medical and surgical instruments will not transmit
any infectious agents to the patients in the health care facilities. Also it is absolutely necessary the
application of the appropriate policies concerning the correct procedures of disinfection and sterili-
zation as imposed by the contemporary nursing science.

Key words
Disinfectants, antiseptics, definitions, policy.

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Ð. ÓÔÁÌÁÔÁÊÇ - ÓÙÔÇÑÏÐÏÕËÏÕ
Âéâëéïãñáößá
1. Ìðáñáìðïýôçò IÃ. Ôï Ðñüâëçìá ôùí Ëïéìþîåùí óôç ÌÅÈ. Óôï:
ÅíôáôéêÞ Èåñáðåßá Ëïéìþîåéò, Ìðáëôüðïõëïò Ã (Åêä), É.Ð.×.
Ðáó÷áëßäçò, ÁèÞíá, 2004, 55-70.
2. Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes
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ìïõ-ËáäÜ Å, Ìáñãáñßôç Ã, ÐÜãêáëç Á. ÁðïëõìáíôéêÜ-Áíôéóç-
ðôéêÜ. Óôï: ÐïëéôéêÞ ÷ñÞóçò áðïëõìáíôéêþí-áíôéóçðôéêþí óôï
÷þñï ôïõ Íïóïêïìåßïõ. ÅëëçíéêÞ ÌéêñïâéïëïãéêÞ Eôáéñåßá,
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18. Wilcox MH, Fawley WN, Wigglesworth N, Parnell P, Verity P,
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4-ereunitiki.qxd 14/10/2009 2:36 Page 191

ÅñåõíçôéêÞ Åñãáóßá

Ï ñüëïò ôïõ åñãáóôçñßïõ ÊÝíôñïõ Õãåßáò óôçí ðñùôïâÜèìéá

ðåñßèáëøç

Ê. ÁäÜì, Ì. Èåïäþñïõ, Ã. Ìáí, Í. Êáôóïýëçò, Á. ÍéêïëÝñç, Ð. ÃêáìðñéÝë

Ìéêñïâéïëïãéêü ÅñãáóôÞñéï ÊÝíôñïõ Õãåßáò Éóôéáßáò, Ãåíéêü Íïóïêïìåßï ×áëêßäáò

Ðåñßëçøç

Ç ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò áðïôåëåß âáóéêü óõóôáôéêü óôïé÷åßï ôïõ óõóôÞìáôïò õãåßáò ìß-
áò ÷þñáò, êáèþò äéåõêïëýíåé ôçí ðñüóâáóç ôùí ðïëéôþí óôéò õðçñåóßåò õãåßáò, ðïõ ðáñÝ÷ïíôáé 191
üóï ôï äõíáôüí ðëçóéÝóôåñá óôï ÷þñï äéáìïíÞò êáé åñãáóßáò ôïõò.. Ç ÐñùôïâÜèìéá Öñïíôßäá
Õãåßáò óôçí ÅëëÜäá ðåñéëáìâÜíåé õðçñåóßåò ðïõ áöïñïýí ôçí ðñüëçøç, äéÜãíùóç êáé èåñáðåõ-
ôéêÞ áãùãÞ ôçò íüóïõ, ÷ùñßò íá áðáéôåßôáé ç ðáñáµïíÞ ôïõ áôüµïõ ãéá íïóçëåßá óå íïóïêïìåßï êáé
ðáñÝ÷åôáé áðü ôïõò ãåíéêïýò-ïéêïãåíåéáêïýò éáôñïýò, ôá ÊÝíôñá Õãåßáò, ôá åîùôåñéêÜ éáôñåßá ôùí
Íïóïêïìåßùí, ôá éáôñåßá ôùí áóöáëéóôéêþí ôáìåßùí êáé ôá äçìïôéêÜ éáôñåßá. Óêïðüò ôçò ðáñïýóáò
åñãáóßáò Þôáí, ìÝóá áðü ôçí áíáëõôéêÞ êáôáãñáöÞ ôçò ëåéôïõñãßáò ôïõ Ìéêñïâéïëïãéêïý åñãáóôç-
ñßïõ ôïõ ÊÝíôñïõ Õãåßáò Éóôéáßáò, ç áðåéêüíéóç ôçò ðáñå÷üìåíçò ðñùôïâÜèìéáò åñãáóôçñéáêÞò
öñïíôßäáò áðü ôï åñãáóôÞñéï ôïõ óõãêåêñéìÝíïõ ÊÝíôñï Õãåßáò. Õëéêü ôçò åñãáóßáò áðïôÝëåóáí
9.048 Üôïìá ðïõ ðñïóÞëèáí óôï ÊÝíôñï Õãåßáò êáé ôá ïðïßá, ìåôÜ ôçí êëéíéêÞ ôïõò åîÝôáóç óôá
ôáêôéêÜ éáôñåßá Þ óôï éáôñåßï åðåéãüíôùí ðåñéóôáôéêþí, ðáñáðÝìöèçêáí óôï Ìéêñïâéïëïãéêü åñãá-
óôÞñéï ãéá ðåñáéôÝñù Ýëåã÷ï. Áí êáé ôï öÜóìá ôùí åêôåëïýìåíùí ìéêñïâéïëïãéêþí åîåôÜóåùí Þôáí
ðåñéïñéóìÝíï, ôï åñãáóôÞñéï áíôáðïêñßèçêå óôç æÞôçóç åíüò ìåãÜëïõ áñéèìïý åîåôÜóåùí, ðïõ êá-
ôÜ ôç äéÜñêåéá ôïõ Ýôïõò 2008 Ýöôáóå ôéò 98.469 åîåôÜóåéò. ÊáôÜ ôçí ôïõñéóôéêÞ ðåñßïäï äéáðéóôþ-
èçêå äéðëÜóéá æÞôçóç óå üëá ôá åßäç ôùí ìéêñïâéïëïãéêþí åîåôÜóåùí, ôüóï óôá åðåßãïíôá üóï êáé
óôá ðñïãñáììáôéóìÝíá ðåñéóôáôéêÜ. ÅðéðëÝïí, ôá êëéíéêÜ áßôéá äå öÜíçêå íá Þôáí ç âáóéêÞ ðáñÜ-
ìåôñïò óôçí åðéëïãÞ ôùí æçôïýìåíùí åîåôÜóåùí, åíþ óõ÷íÜ äå ãéíüôáí Ýëåã÷ïò áõôþí áðü åéäéêü
éáôñü. ¸íáò éäéáßôåñá ìåãÜëïò áñéèìüò åîåôÜóåùí ðïõ æçôÞèçêå áðü ôï Ìéêñïâéïëïãéêü åñãáóôÞ-
ñéï ðáñïõóßáóå áðïôåëÝóìáôá ÷ùñßò ðáèïëïãéêÜ åõñÞìáôá, ìå óõíÝðåéá, ôüóï ôçí áýîçóç ôïõ
êüóôïõò ëåéôïõñãßáò ôïõ åñãáóôçñßïõ, üóï êáé ôçí Üóêïðç åðéâÜñõíóÞ ôïõ. ¼óïí áöïñÜ ôá óõ-
íïäÜ ðáñáðåìðôéêÜ, áõôÜ õðïãñÜöïíôáí áðü áãñïôéêïýò éáôñïýò, óõ÷íÜ ÷ùñßò ôéò áðáñáßôçôåò
êëéíéêÝò ðëçñïöïñßåò ãéá ôçí ïëïêëÞñùóç ôùí åîåôÜóåùí áðü ôï åñãáóôÞñéï. ÓõìðåñáóìáôéêÜ,
áðü ôá áðïôåëÝóìáôá ôçò ðáñïýóáò åñãáóßáò, ðñïêýðôåé ï óçìáíôéêüò ñüëïò ðïõ äéáäñáìáôßæåé

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
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Ê. ÁÄÁÌ, Ì. ÈÅÏÄÙÑÏÕ, Ã. ÌÁÍ ÊÁÉ ÓÕÍ.
ôï Ìéêñïâéïëïãéêü åñãáóôÞñéï óôç äéáäéêáóßá ðåñßèáëøçò ôùí áóèåíþí ôïõ ÊÝíôñïõ Õãåßáò Éóôéáß-
áò, üðùò êáé ï êáèïñéóôéêüò ñüëïò ôïõ åéäéêïý Âéïðáèïëüãïõ óôçí ïñèïëïãéêÞ ÷ñÞóç ôùí õðçñå-
óéþí õãåßáò áðü ôï åñãáóôÞñéï, ðñïò üöåëïò ôçò õãåßáò ôïõ ðëçèõóìïý ôçò ðåñéï÷Þò åõèýíçò ôïõ.
ËÝîåéò êëåéäéÜ
ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, ÊÝíôñá Õãåßáò, Ìé-
êñïâéïëïãéêü ÅñãáóôÞñéï, ÉáôñéêÞ Âéïðáèïëïãßá.
ÅéóáãùãÞ
1. ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò – ïñéóìüò. Ç ðïëé-
ôéêÞ õãåßáò, ùò ìÝñïò ôçò êïéíùíéêÞò ðïëéôéêÞò åíüò
êñÜôïõò, åîáñôÜôáé êáé êáèïñßæåôáé åí ðïëëïßò áðü
ôéò óõíïëéêÝò ðïëéôéêÝò, ôéò óõãêñïýóåéò êáé ôá óõì-
öÝñïíôá, êáèþò êáé ôçí êïéíùíéêÞ - ïéêïíïìéêÞ êáôÜ-
óôáóç ìéáò ÷þñáò óå êÜèå äåäïìÝíç éóôïñéêÞ
ðåñßïäï. Óýìöùíá ìå ôïí Ðáãêüóìéï Ïñãáíéóìü
Õãåßáò (ÐÏÕ), ç õãåßá ïñßæåôáé ùò "ç êáôÜóôáóç ðëÞ-
ñïõò óùìáôéêÞò, øõ÷éêÞò êáé êïéíùíéêÞò åõåîßáò êáé
ç áðïõóßá íüóïõ Þ áíáðçñßáò". Ìå ôïí ïñéóìü áõôü
ùò âÜóç, ç ðïëéôéêÞ õãåßáò ïöåßëåé íá ðåñéëáìâÜíåé
ðïëéôéêÝò ðñüëçøçò, ðñïáãùãÞò ôçò õãåßáò, èåñá-
ðåßáò êáé áðïêáôÜóôáóçò.1
Ç äéÜñèñùóç êáé äïìÞ ôùí õðçñåóéþí õãåßáò áðï-
ôåëåß óçìáíôéêü ðáñÜãïíôá äéá÷åßñéóçò êáé áðïôåëå-
óìáôéêüôçôáò ôïõ óõóôÞìáôïò äçìüóéáò õãåßáò. Ïé
192
õðçñåóßåò õãåßáò óôçí ÅëëÜäá áñèñþíïíôáé óå ôñßá
åðßðåäá: ðñùôïâÜèìéï, äåõôåñïâÜèìéï êáé ôñéôïâÜè-
ìéï, êáèÝíá áðü ôá ïðïßá áíáöÝñåôáé óå äéáöïñåôéêü
ðëçèõóìü êáé ðáñÝ÷åé äéáöïñåôéêÝò õðçñåóßåò. Ôï
ðñùôïâÜèìéï åðßðåäï áðïôåëåß ôçí ðñþôç åðáöÞ ôïõ
ðïëßôç ìå ôéò õðçñåóßåò õãåßáò êáé ôïõò ëåéôïõñãïýò
ôçò êáé ðáñÝ÷åé õðçñåóßåò ðñüëçøçò, ðñïáãùãÞò ôçò
õãåßáò, äéÜãíùóçò, èåñáðåßáò êáé áðïêáôÜóôáóçò,
÷ùñßò åéóáãùãÞ ôïõ óå íïóçëåõôéêü ßäñõìá.
Óýìöùíá ìå ôï ó÷Ýäéï íüìïõ ãéá ôçí "ïñãÜíùóç
êáé ëåéôïõñãßá ôçò ðñùôïâÜèìéáò öñïíôßäáò õãåßáò",
ùò ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò (ÐÖÕ) ïñßæåôáé ôï
óýóôçìá ðáñï÷Þò õðçñåóéþí öñïíôßäáò õãåßáò, ðïõ
åîáóöáëßæåé ôçí éóüôéìç ðñüóâáóç üëïõ ôïõ ðëçèõ-
óìïý óå áõôÝò êáé áðïóêïðåß óôçí ðñüëçøç, äéáôÞ-
ñçóç, ðñïáãùãÞ, áðïêáôÜóôáóç êáé åíäõíÜìùóç ôçò
õãåßáò ôïõ ìå ôçí ðáñï÷Þ ðéóôïðïéçìÝíùí éáôñéêþí
õðçñåóéþí, åîåôÜóåùí êáé öáñìÜêùí.
Ç ÐÖÕ ðåñéëáìâÜíåé éáôñéêÝò êáé íïóçëåõôéêÝò
õðçñåóßåò ìå óêïðü ôçí ðñüëçøç êáé áðïêáôÜóôáóç
âëáâþí ôçò õãåßáò ðïõ äåí áðáéôïýí ôç íïóçëåßá óå
íïóïêïìåßï, éáôñéêÝò åîåôÜóåéò óýìöùíåò ìå ðñùôü-
êïëëá ðñüëçøçò, äéÜãíùóçò êáé èåñáðåßáò, ðñïëç-
VOL. 54 • ISSUE 4, July - August 2009
Yðåýèõíïò áëëçëïãñáößáò
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ðôéêÞ ïäïíôéáôñéêÞ öñïíôßäá, öñïíôßäá áóèåíþí ìåôÜ
ôçí Ýîïäï áðü ôï íïóïêïìåßï, õðçñåóßåò áíïéêôÞò
öñïíôßäáò êáé öñïíôßäáò óôï óðßôé, åðåßãïõóá ìåôá-
öïñÜ áóèåíþí ìÝóù ôïõ ÅÊÁÂ, ÷ïñÞãçóç öáñìáêåõ-
ôéêÞò áãùãÞò, ðáñï÷Þ åî áðïóôÜóåùò óõìâïõëþí ìå
÷ñÞóç ðñïçãìÝíùí ôå÷íïëïãéþí, ìÝôñá õãåßáò óôïí
ôïìÝá ôçò ðñüëçøçò óôá êñßóéìá ðñïâëÞìáôá ôùí
åðéäçìéþí êáé ôùí ðáñáãüíôùí êéíäýíïõ ãéá ôçí õãåßá,
üðùò ðá÷õóáñêßá, ÷ñÞóç áëêïüë, êáðíïý êáé íáñêù-
ôéêþí.2
Ç ìåôáðïëåìéêÞ ïéêïíïìéêÞ áíÜðôõîç åðÝöåñå
âåëôßùóç óôï åðßðåäï õãåßáò ôïõ ðëçèõóìïý, åíþ Üë-
ëáîå êáé ôçí áíôßëçøç ãéá ôçí õãåßá. Ìå âÜóç ôéò íå-
üôåñåò áíôéëÞøåéò, õãåßá äåí èåùñåßôáé ðëÝïí ìüíï ç
áðïõóßá íüóïõ. Ï ïñéóìüò ôçò õãåßáò áðïêôÜ åõñý-
ôåñï ðåñéå÷üìåíï êáé åìðåñéÝ÷åé üëåò ôéò óõíéóôþóåò
ôçò áíèñþðéíçò ýðáñîçò. ÐáñÜëëçëá, ç ïéêïíïìéêÞ
áíÜðôõîç êáé êïéíùíéêÞ âåëôßùóç ôïõ ðëçèõóìïý, óå
óõíäõáóìü ìå ôçí åêñçêôéêÞ ôå÷íïëïãéêÞ ðñüïäï
ïäÞãçóáí óôçí ôåñÜóôéá áýîçóç ôùí äáðáíþí ãéá
ôçí õãåßá. Ïé áëëáãÝò áõôÝò ïäÞãçóáí óôçí áíÜãêç
åðáíáðñïóäéïñéóìïý ôùí ðïëéôéêþí õãåßáò êáé åðá-
íáó÷åäéáóìïý ôùí õðçñåóéþí õãåßáò. ÅðéðëÝïí, áíá-
ãíùñßóôçêå áðü ôç äéåèíÞ åðéóôçìïíéêÞ êïéíüôçôá üôé
ç ðñüëçøç åßíáé ðñïôéìüôåñç ôçò èåñáðåßáò êáé ç
ðëÝïí óõìöÝñïõóá ïéêïíïìéêÜ åðéëïãÞ.
Óôçí ¢ëìá-¢ôá ôçò ÅÓÓÄ, ðïõ óõíÞëèå ôï 1978, ï
ÐÏÕ ðñïóäéüñéóå ôçí ÐÖÕ ùò "ôçí ïõóéáóôéêÞ öñï-
íôßäá ðïõ âáóßæåôáé óå ìåèüäïõò ðñáêôéêÜ, åðéóôç-
ìïíéêÜ êáé êïéíùíéêÜ áðïäåêôÝò, åßíáé ðñïóéôÞ óå üëá
ôá Üôïìá êáé ôéò ïéêïãÝíåéåò ôçò êïéíüôçôáò ðïõ óõì-
ìåôÝ÷ïõí åíåñãÜ óôï ó÷åäéáóìü êáé ôéò äñáóôçñéü-
ôçôÝò ôçò".3
Óôç óõíÝ÷åéá, ôï 1985, ï ÐÏÕ êáèüñéóå ôç Óôñá-
ôçãéêÞ Õãåßáò ãéá üëïõò ôï 2000, åîåéäéêåýïíôáò 38
óôü÷ïõò, ìåôáîý ôùí ïðïßùí "üëá ôá êñÜôç-ìÝëç, ìÝ-
óù ôçò áðïôåëåóìáôéêÞò áíôéðñïóþðåõóçò êáé óõì-
ìåôï÷Þò ôçò êïéíüôçôáò ðñÝðåé íá áíáðôýîïõí
óõóôÞìáôá õãåßáò ðïõ íá âáóßæïíôáé óôçí ðñùôïâÜè-
ìéá öñïíôßäá õãåßáò êáé íá õðïóôçñßæïíôáé áðü äåõ-
ôåñïâÜèìéá êáé ôñéôïâÜèìéá ðåñßèáëøç".4
4-ereunitiki.qxd 14/10/2009 2:36 Page 193
?????? ?????? ???????? ???? ???????ÐÑÙÔÏÂÁÈÌÉÁ
2. ÐÖÕ óôçí ÅëëÜäá – éóôïñéêÞ áíáäñïìÞ. Ïé ðñï-
óðÜèåéåò ãéá ôçí ïñãÜíùóç ÐÖÕ óôçí ÅëëÜäá åßíáé
óõíå÷åßò, áëëÜ áíáðïôåëåóìáôéêÝò. Óôçí ðñïðïëåìé-
êÞ ðåñßïäï ìéá ðñùôüëåéá ìïñöÞ ïéêïãåíåéáêïý éá-
ôñïý åðéêñÜôçóå, åíþ ìåôáðïëåìéêÜ ðåñÜóáìå óôïõò
áãñïôéêïýò õãåéïíïìéêïýò ó÷çìáôéóìïýò, ôïõò êïé-
íïôéêïýò éáôñïýò êáé ôá ÊÝíôñá Õãåßáò ôïõ ÅÓÕ.5 Ï í.
2592/1953 ðñïÝâëåøå ôç äçìéïõñãßá "êïéíïôéêþí
õãåéïíïìéêþí óôáèìþí" ùò Ýíá ðñþôï âÞìá ïñãÜíù-
óçò ôçò ÐÖÕ óôçí ðåñéöÝñåéá, åíþ ï í. 3487/1955 èå-
óìïèÝôçóå ôçí ßäñõóç êïéíïôéêþí êáé áãñïôéêþí
éáôñåßùí óôç ÷þñá. Óôá 1960 Ýãéíå áðüðåéñá åéóáãù-
ãÞò ôïõ èåóìïý ôïõ ïéêïãåíåéáêïý éáôñïý áðü ôï ÉÊÁ.
ÊáôÜ ôï äéÜóôçìá 1977-1980, ï êáèçãçôÞò ÄïîéÜäçò
êáôÞñôéóå ó÷Ýäéï íüìïõ óôçí áéôéïëïãéêÞ Ýêèåóç ôïõ
ïðïßïõ áíáöÝñåé: "…íá äþóåé Ýìöáóç óôçí ðñùôï-
âÜèìéá öñïíôßäá ãéá ôçí õãåßá. ¸ìöáóç ðïõ Ý÷åé ãßíåé
äéåèíþò ðáñáäåêôÞ ùò ï êýñéïò óôü÷ïò üðïõ ðñÝðåé
íá áðïâëÝðïõí üëåò ïé õðçñåóßåò õãåßáò ìéáò ÷þñáò.
…ðñï÷ùñåß óôçí áíáìüñöùóç ôçò ðñùôïâÜèìéáò
öñïíôßäáò ãéá ôïí áãñïôéêü êáé çìéáóôéêü ðëçèõóìü".
ÔåëéêÜ ôï íïìïó÷Ýäéï ÄïîéÜäç äåí øçößóôçêå ðïôÝ.6
Ï í. 1397/1983 ÷áñáêôçñßóôçêå ùò ç óçìáíôéêüôå-
ñç ðñïóðÜèåéá ðïõ Ýãéíå ðïôÝ óôçí ÅëëÜäá, ãéá ìéá
ñéæéêÞ ìåôáññýèìéóç óôïí ôïìÝá ôçò õãåßáò. Ç öéëï-
óïößá ôïõ âáóßóôçêå óôçí áñ÷Þ üôé ç õãåßá åßíáé êïé-
íùíéêü áãáèü êáé ðñÝðåé íá ðáñÝ÷åôáé ìå åõèýíç ôïõ
êñÜôïõò óôï óýíïëï ôïõ ðëçèõóìïý áíåîÜñôçôá áðü
ôçí êïéíùíéêÞ Þ ïéêïíïìéêÞ êáôÜóôáóç ôïõ êÜèå ðï-
ëßôç. Ùò ðñïò ôçí ÐÖÕ ðñïÝâëåøå ôçí áíÝãåñóç, åîï-
ðëéóìü êáé óôåëÝ÷ùóç 400 ÊÝíôñùí Õãåßáò óå
áãñïôéêÝò êáé áóôéêÝò ðåñéï÷Ýò, áðü ôá ïðïßá ôá 200
ðåñßðïõ èá êÜëõðôáí ôï óýíïëï ôïõ áãñïôéêïý ðëç-
èõóìïý êáé ôá õðüëïéðá ôéò áíÜãêåò ôïõ áóôéêïý ðëç-
èõóìïý. Áðü áõôÜ ëåéôïýñãçóáí ôåëéêÜ 177 ÊÝíôñá
Õãåßáò óôéò áãñïôéêÝò ðåñéï÷Ýò, åíþ ôá ÊÝíôñá Õãåß-
áò áóôéêïý ôýðïõ åãêáôáëåßöèçêáí, ìå óõíÝðåéá íá
óõíå÷ßæåôáé ìÝ÷ñé óÞìåñá ï êáôáêåñìáôéóìüò, ïé áë-
ëçëïåðéêáëýøåéò, ïé õãåéïíïìéêÝò áíéóüôçôåò êáé ç
óðáôÜëç óôçí ðáñï÷Þ ôçò ÐÖÕ.
Ï í. 2071/1992 äéåýñõíå ôçí Ýííïéá ôçò ÐÖÕ, óõ-
ìðåñéëáìâÜíïíôáò óå áõôÞ åíÝñãåéåò ðñüëçøçò êáé
ðåñßèáëøçò ãéá ìéêñÝò âëÜâåò ôçò õãåßáò, üðïõ äåí
÷ñåéÜæåôáé åéóáãùãÞ óå íïóïêïìåßï. Ï í. 2519/1997
áðïðåéñÜôáé íá áíáâáèìßóåé ôéò õðçñåóßåò ðáñï÷Þò
ÐÖÕ óôçí ýðáéèñï, ìå ôçí êáôÜñãçóç ôçò õðï÷ñåù-
ôéêÞò õðçñåóßáò õðáßèñïõ (Í.Ä. 67/1968), áíôéêáèé-
óôþíôáò ôïõò ìå åéäéêåõüìåíïõò éáôñïýò, ðïõ óôï
ðëáßóéï ôçò åéäßêåõóÞò ôïõò õðçñåôïýí óôá ÊÝíôñá
Õãåßáò, êáèþò åðßóçò ìå éáôñïýò, êáôü÷ïõò åéäéêüôç-
ôáò ãåíéêÞò éáôñéêÞò, áëëÜ êáé ìå ôçí Ýíôáîç ôùí ìï-
íßìùí áãñïôéêþí éáôñþí óå êëÜäï éáôñþí ÅÓÕ.
ÓÞìåñá ç ðáñáãùãÞ êáé äéáíïìÞ ÐÖÕ óôçí ÅëëÜ-
äá åßíáé êáôáêåñìáôéóìÝíç êáé ðáñÝ÷åôáé áðü:
• Ôá ÊÝíôñá Õãåßáò êáé Ðïëõäýíáìá ÐåñéöåñåéáêÜ
Éáôñåßá ôïõ ÅÓÕ.
????????????ÅÑÃÁÓÔÇÑÉÁÊÇ ÖÑÏÍÔÉÄÁ
??? Blastocystis sp.
• Ôá åîùôåñéêÜ éáôñåßá ôùí Íïóïêïìåßùí ôïõ ÅÓÕ.
• Ôïõò êëÜäïõò õãåßáò ôùí áóöáëéóôéêþí ôáìåßùí
ìÝóù ðïëõúáôñåßùí êáèþò êáé óõìâåâëçìÝíùí éá-
ôñþí, éáôñéêþí åñãáóôçñßùí êáé äéáãíùóôéêþí êÝ-
íôñùí.
• Ôéò ìïíÜäåò ðáñï÷Þò ÐÖÕ ôùí ÏÔÁ.
• Ôïí éäéùôéêü ôïìÝá (éáôñåßá, éáôñéêÜ åñãáóôÞñéá,
äéáãíùóôéêÜ êÝíôñá),
Ç êáôÜóôáóç óÞìåñá óôá ÊÝíôñá Õãåßáò ôùí
áãñïôéêþí êáé çìéáóôéêþí ðåñéï÷þí, ðáñüôé ðÝôõ÷áí
íá áõîÞóïõí ôç äéáèåóéìüôçôá êáé ðñïóðåëáóéìüôç-
ôá ôïõ áãñïôéêïý ðëçèõóìïý óôç öñïíôßäá õãåßáò,
÷áñáêôçñßæåôáé áðü áíåðáñêÞ óôåëÝ÷ùóç, ôüóï óå
éáôñéêü üóï êáé óå ðñïóùðéêü Üëëùí åéäéêïôÞôùí
õãåßáò, ðëçììåëþò óõíôçñçìÝíåò õðïäïìÝò êáé ðå-
ðáëáéùìÝíï éáôñéêü êáé ëïéðü åîïðëéóìü.
Óôï Áíáðôõîéáêü Ðñüãñáììá ôïõ ôïìÝá Õãåßáò êáé
ÊïéíùíéêÞò Áëëçëåããýçò ôçò ðåñéüäïõ 2007-2013 åêôé-
ìÞèçêå ìåôáîý Üëëùí üôé ôï åðßðåäï õãåßáò ôïõ ðëç-
èõóìïý, áí êáé ó÷åôéêÜ õøçëü, äåí áêïëïõèåß ôïõò
ñõèìïýò âåëôßùóçò ôùí õðïëïßðùí ìåóïãåéáêþí ÷ù-
ñþí, ëüãù êáé ôçò õóôÝñçóçò óôçí ðñüëçøç, ôçí ïñ-
ãÜíùóç ôçò äçìüóéáò õãåßáò êáé ôçò ÐÖÕ êáé ôçí
åëëéðÞ óôåëÝ÷ùóç ôùí áíôéóôïß÷ùí äïìþí. Óôïí ôïìÝá
ôçò øõ÷éêÞò õãåßáò ãßíïíôáé âåëôéþóåéò ìå ðáñáìÝíïõ-
óåò áäõíáìßåò óôçí ðñüëçøç êáé ôçí ðñùôïâÜèìéá ðå-
ñßèáëøç. ÁíáöïñéêÜ ìå ôç ÷ñçìáôïäüôçóç ôïõ ôïìÝá
õãåßáò ôçò ÅëëÜäáò, ðáñáôçñåßôáé ìéá óõíå÷Þò áýîç-
óç ôùí éäéùôéêþí äáðáíþí õãåßáò, ìå ôïí êýñéï üãêï
íá ãßíåôáé ìå áð' åõèåßáò ðëçñùìÝò, óå âÜñïò ôùí ïé-
êïãåíåéáêþí åéóïäçìÜôùí.7
ÅîáéñåôéêÜ èåôéêÞ êñßíåôáé ç äçìéïõñãßá åèíéêïý
äéêôýïõ ÐÖÕ, êáèþò êáé ç êáèéÝñùóç çëåêôñïíéêÞò 193
êÜñôáò õãåßáò ôïõ êÜèå ðïëßôç, óôçí ïðïßá èá êáôá-
÷ùñïýíôáé üëåò ïé ðáñå÷üìåíåò éáôñéêÝò õðçñåóßåò
êáé åîåôÜóåéò, üðùò êáé ç ÷ïñçãïýìåíç öáñìáêåõôé-
êÞ áãùãÞ, óýìöùíá ìå óõãêåêñéìÝíá ðñùôüêïëëá
äéÜãíùóçò, ðñüëçøçò êáé èåñáðåßáò (Ðñùôüêïëëá
Éáôñéêþí ÐñÜîåùí êáé ÖáñìÜêùí ÐñùôïâÜèìéáò
Öñïíôßäáò Õãåßáò, Üñèñï 3 ôïõ íÝïõ áíáèåùñçìÝíïõ
ó÷åäßïõ íüìïõ, 2009).
ÊÝíôñï Õãåßáò Éóôéáßáò
1. ÃåùãñáöéêÞ ÷ùñïèÝôçóç. Ôï ÊÝíôñï Õãåßáò Éóôéáß-
áò (ÊÕÉ) åäñåýåé óôï ÄÞìï Éóôéáßáò, óôá âüñåéá ôïõ
Íïìïý Åõâïßáò, êáé ÷áñáêôçñßæåôáé ùò ðñïâëçìáôéêü
êáé Üãïíï Á´ êáôçãïñßáò áðü ôï Ðñïåäñéêü ÄéÜôáãìá
õð' áñéè. 131/1987, ëüãù ôùí êïéíùíéêþí, ãåùãñáöé-
êþí, óõãêïéíùíéáêþí êáé ïéêéóôéêþí óõíèçêþí. Ôï ÊÕÉ
áíÞêåé ïñãáíéêÜ óôï Ãåíéêü Íïìáñ÷éáêü Íïóïêïìåßï
×áëêßäáò êáé ðáñÝ÷åé õðçñåóßåò õãåßáò óå ôÝóóåñéò
ÄÞìïõò (Áéäçøïý, Áñôåìéóßïõ, Éóôéáßáò, Ùñåþí), ìå ôá
áíôßóôïé÷á 25 äçìïôéêÜ äéáìåñßóìáôá, êáé ôçí êïéíüôç-
ôá Ëé÷Üäáò, óõíïëéêïý ðëçèõóìïý 22.722 (áðïãñáöÞ
ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009
4-ereunitiki.qxd 14/10/2009 2:36 Page 194
Ê. ÁÄÁÌ, Ì. ÈÅÏÄÙÑÏÕ, Ã. ÌÁÍ ÊÁÉ ÓÕÍ.
2001). Ï ðëçèõóìüò åõèýíçò ôïõ ÊÕÉ áõîÜíåôáé áí
ðñïóìåôñçèåß ç ðñïóÝëåõóç óôï Ìéêñïâéïëïãéêü åñ-
ãáóôÞñéï ôïõ ÊÕÉ êáôïßêùí áðü ôïõò üìïñïõò ÄÞìïõò
(Åëõìíßùí, ÊçñÝùò, ÍçëÝùò), êáèþò êáé áëëïäáðþí
êáôïßêùí ôçò åõñýôåñçò ðåñéï÷Þò êáé ðïëëáðëáóéÜæå-
ôáé êáôÜ ôçí ôïõñéóôéêÞ ðåñßïäï.
Õðü ôçí åðïðôåßá ôïõ ÊÕÉ âñßóêïíôáé åðôÜ Ðåñé-
öåñåéáêÜ Éáôñåßá (ÐÉ) ôá ïðïßá Ý÷ïõí ôéò Ýäñåò ôïõò
óôá äçìïôéêÜ äéáìåñßóìáôá Áãßïõ, Ëïõôñþí Áéäçøïý,
ÃáëáôóÜäùí, Ãïõâþí, Êñõïíåñßôç, Ùñåþí êáé Ëé÷Ü-
äáò (Åéêüíá 1).
Ôï ÊÕÉ ðáñÝ÷åé äùñåÜí éáôñéêÝò õðçñåóßåò êáé âá-
óéêü åñãáóôçñéáêü Ýëåã÷ï óå üëïõò ôïõò êáôïßêïõò,
áíåîÜñôçôá áðü ôï áóöáëéóôéêü ôïõò öïñÝá. Ïìïß-
ùò äùñåÜí ðåñßèáëøç ðáñÝ÷åé óôïõò áíáóöÜëéóôïõò
êáé óôïõò ôïõñßóôåò.
2. ÓôåëÝ÷ùóç ôïõ ÊÕÉ. Ôï ÊÕÉ, üðùò êáé ôá õðüëïé-
ðá ÊÝíôñá Õãåßáò ôçò ÅëëÜäáò, Ý÷åé ùò óêïðü ôçí
ðáñï÷Þ ÐÖÕ óå üëïõò ôïõò ìüíéìïõò êáé ðñïóùñé-
íïýò êáôïßêïõò ôçò Âüñåéáò Åýâïéáò. ÁõôÞ ðåñéëáì-
âÜíåé ôçí ðñùôïâÜèìéá éáôñéêÞ ðåñßèáëøç, ôçí
Üóêçóç ðñïëçðôéêÞò éáôñéêÞò êáé ïäïíôéáôñéêÞò, ôçí
åðéäçìéïëïãéêÞ Ýñåõíá, ôçí áãùãÞ õãåßáò, êáèþò åðß-
óçò êáé ôçí åíçìÝñùóç êáé åêðáßäåõóç ôïõ éáôñéêïý
êáé íïóçëåõôéêïý ðñïóùðéêïý. ÓõãêåêñéìÝíá óôï ÊÕÉ
ëåéôïõñãïýí:
• Éáôñåßá ÃåíéêÞò ÉáôñéêÞò 3 (ôñßá)
• Éáôñåßï Åðåéãüíôùí Ðåñéóôáôéêþí 1 (Ýíá)
• Éáôñåßï Ðáéäéáôñéêü 1 (Ýíá)
• Éáôñåßá ÏäïíôéáôñéêÜ 2 (äýï)
• Áêôéíïëïãéêü åñãáóôÞñéï
• Ìéêñïâéïëïãéêü åñãáóôÞñéï
194
¼óïí áöïñÜ ôç óôåëÝ÷ùóÞ ôïõ óå éáôñéêü äõíá-
ìéêü, êáôÜ ôçí ðåñßïäï äéåîáãùãÞò ôçò Ýñåõíáò, óôï
ÊÕÉ õðçñåôïýí 4 ãåíéêïß/ïéêïãåíåéáêïß éáôñïß, 1 ðáéäß-
VOL. 54 • ISSUE 4, July - August 2009
áôñïò, 1 âéïðáèïëüãïò, 1 áêôéíïëüãïò, 2 ïäïíôßá-
ôñïé, 1 åðéêïõñéêüò êáñäéïëüãïò (áðü ôïí Éïýíéï ôïõ
2008), 1 åðéêïõñéêüò ðáèïëüãïò (áðü ôïí Ïêôþâñéï
ôïõ 2008) êáé 4 áãñïôéêïß éáôñïß, åíþ óôá ÐÉ õðçñå-
ôïýí áðü 1 Ýùò 2 áãñïôéêïß éáôñïß áíÜ éáôñåßï.
3. ÓôåëÝ÷ùóç-åîïðëéóìüò Ìéêñïâéïëïãéêïý åñãá-
óôçñßïõ. Ôï Ìéêñïâéïëïãéêü åñãáóôÞñéï áðáó÷ïëåß
Ýíáí éáôñü Béïðáèïëüãï, äýï ôå÷íïëüãïõò êáé ìßá
ãñáììáôÝá êáé ðáñÝ÷åé õðçñåóßåò õãåßáò óå üëïõò
ôïõò áóèåíåßò ðïõ ðñïóÝñ÷ïíôáé êáèçìåñéíÜ ãéá åîå-
ôÜóåéò ñïõôßíáò ìå ðñïãñáììáôéóìÝíá ñáíôåâïý êáé
óå ðñùéíü ùñÜñéï. ÊáôÜ ôçí áðïãåõìáôéíÞ âÜñäéá
ôùí ôå÷íïëüãùí êáé êáôÜ ôéò åöçìåñßåò ôïõ éáôñïý
Béïðáèïëüãïõ, äéåíåñãåßôáé âéï÷çìéêüò Ýëåã÷ïò ôùí
åðåéãüíôùí ðåñéóôáôéêþí ðïõ ðñïóÝñ÷ïíôáé óôï ÊÝ-
íôñï Õãåßáò, åíþ ï áéìáôïëïãéêüò áíáëõôÞò ôïõ åñ-
ãáóôçñßïõ åßíáé óôç äéÜèåóç ôùí áãñïôéêþí éáôñþí
üëï ôï 24ùñï ãéá ôéò áíÜãêåò ôçò åöçìåñßáò.
Ôï åñãáóôÞñéï åßíáé åîïðëéóìÝíï ìå áéìáôïëïãé-
êü áíáëõôÞ (Ýôïò êáôáóêåõÞò 2001), âéï÷çìéêü áíá-
ëõôÞ (Ýôïò êáôáóêåõÞò 2000 ìå áíáâÜèìéóç ôïõ
ëïãéóìéêïý ôïõ ôï 2002), áíáëõôÞ ïýñùí (Ýôïò êáôá-
óêåõÞò 2000), åðùáóôéêü êëßâáíï, õäáôüëïõôñï, öõ-
ãüêåíôñï, êáé ìéêñïóêüðéï.
Óêïðüò ôçò ðáñïýóáò åñãáóßáò Þôáí ç áðåéêüíéóç
ôçò ðáñå÷üìåíçò ðñùôïâÜèìéáò åñãáóôçñéáêÞò öñï-
íôßäáò áðü ôï Ìéêñïâéïëïãéêü åñãáóôÞñéï ôïõ ÊÕÉ êáé
óõãêåêñéìÝíá: á) ç êáôáãñáöÞ ôçò óõ÷íüôçôáò æÞôçóçò
ôùí âéï÷çìéêþí åîåôÜóåùí, áëëÜ êáé üëùí ôùí åñãáóôç-
ñéáêþí åîåôÜóåùí, ðïõ áöïñïýí ðñïãñáììáôéóìÝíá êáé
åðåßãïíôá ðåñéóôáôéêÜ, â) ç êáôáãñáöÞ ôçò óõ÷íüôçôáò
ôùí ðáèïëïãéêþí áðïôåëåóìÜôùí ôùí åîåôÜóåùí óå
ó÷Ýóç ìå ôï óõíïëéêü áñéèìü ôùí äéåíåñãïýìåíùí åîå-
ôÜóåùí, ã) ç äéåñåýíçóç ôçò áíáãêáéüôçôáò-÷ñçóéìüôç-
ôáò áõôþí êáé ôÝëïò ä) ç äéåñåýíçóç ôçò óõ÷íüôçôáò
åðáíåëÝã÷ïõ âéï÷çìéêþí åîåôÜóåùí.
Åéêüíá 1. ×Üñôçò ôçò Âüñåéáò Åý-
âïéáò.
4-ereunitiki.qxd 14/10/2009 2:36 Page 195
?????? ?????? ???????? ???? ???????ÐÑÙÔÏÂÁÈÌÉÁ
Õëéêü - ìÝèïäïé
Óõãêåíôñþèçêáí óôïé÷åßá ãéá ôçí êßíçóç ôïõ åñãá-
óôçñßïõ áðü ôá ðåðñáãìÝíá ôïõ åñãáóôçñßïõ êáé
áðü ôá áñ÷åßá ôïõ åñãáóôçñßïõ ãéá ôï Ýôïò 2008, ãéá
ôá ïðïßá Ýãéíå ðéï ëåðôïìåñÞò ìåëÝôç, üðùò ôïõ óõ-
íïëéêïý áñéèìïý ôùí ìéêñïâéïëïãéêþí åîåôÜóåùí êá-
ôÜ ôç äéÜñêåéá ôïõ 2008, ôïõ áñéèìïý ôùí åîåôÜóåùí
áíÜ ìÞíá êáé ôïõ áñéèìïý ôùí ðáñáðåìðôéêþí áíÜ
ìÞíá. ¸ãéíå áðïôýðùóç óå éóôüãñáììá ôïõ áñéèìïý
ôùí ðáñáðåìðôéêþí ôïõ åñãáóôçñßïõ áíÜ ìÞíá êáé
áíÜ êáôçãïñßá ôùí ðáñáðåìðôéêþí óå ôáêôéêÜ (êáèç-
ìåñéíÞò ëåéôïõñãßáò) êáé óå åðåßãïíôá (åöçìåñßáò).
Ãéá íá åßíáé óõãêñßóéìá ôá óôïé÷åßá ôçò êßíçóçò ôïõ
åñãáóôçñßïõ ÷ñçóéìïðïéÞèçêáí êáé óôïé÷åßá áðü ôçí
êßíçóç ôïõ ÊÕÉ ãéá ôï ßäéï ôï Ýôïò. Ôá óôïé÷åßá áõôÜ
áíáöÝñïíôáé óôá áßôéá ðñïóÝëåõóçò ôùí áóèåíþí,
óôçí êáôáíïìÞ êßíçóçò ôáêôéêþí êáé åêôÜêôùí éáôñåß-
ùí, óôçí êáôáíïìÞ êßíçóçò ôïõ óõíüëïõ ôùí éáôñåßùí
êáé óôçí êáôáíïìÞ ôïõ áñéèìïý ôùí åñãáóôçñéáêþí
åîåôÜóåùí.
Õëéêü ôçò åñãáóßáò ìáò áðïôÝëåóå ôï óýíïëï ôùí
åîåôÜóåùí ðïõ Ýãéíáí óôï Ìéêñïâéïëïãéêü åñãáóôÞñéï
ôïõ ÊÕÉ êáôÜ ôç äéÜñêåéá ôïõ Ýôïõò 2008. Ãéá ôï ëüãï
áõôü ìåëåôÞèçêáí áíáëõôéêÜ 9.048 Üôïìá ðïõ ðñïóÞë-
èáí óôï ÊÕÉ Þ ôá ÐÉ êáé åîåôÜóôçêáí óôá ôáêôéêÜ éáôñåßá
(5.975 Üôïìá), óôï éáôñåßï åðåéãüíôùí ðåñéóôáôéêþí
(2.001 Üôïìá) Þ ðáñáðÝìöèçêáí óôï Ìéêñïâéïëïãéêü
åñãáóôÞñéï ôïõ ÊÝíôñïõ Õãåßáò áðü éäéþôç êëéíéêü éá-
ôñü (1.072). Ç ìÝóç çëéêßá ôùí áóèåíþí Þôáí 59,8 åôþí,
êáé üóïí áöïñÜ ôï öýëï, 5.415 Þôáí ãõíáßêåò (59,8%)
êáé 3.633 Üíäñåò (40,2%). Áðü ôï õëéêü åîáéñÝèçêáí ôá
ðáéäéÜ çëéêßáò ìÝ÷ñé 16 åôþí, ãéáôß ç áíôéðñïóþðåõóÞ
ôïõò óôï õðü ìåëÝôç äåßãìá Þôáí áìåëçôÝá. Ùò ðñïò
ôï åßäïò ôçò áóöáëéóôéêÞò
êÜëõøçò, 3.140 áóèåíåßò
(34,7%) åß÷áí ùò áóöáëéóôé-
êü öïñÝá ôïí ÏÃÁ, 2.542
(28,1%) ôï ÉÊÁ, 1.060 (11,7%)
ôï Äçìüóéï, 868 (9,6%) Üëëá
ôáìåßá êáé 1.438 (15,9%) Þôáí
áíáóöÜëéóôïé.
Åéêüíá 2. Áñéèìüò ðáñáðåìðôéêþí
êáôÜ ôç ÷åéìåñéíÞ êáé ôïõ-
ñéóôéêÞ ðåñßïäï ôïõ Ýôïõò
2008.
????????????ÅÑÃÁÓÔÇÑÉÁÊÇ ÖÑÏÍÔÉÄÁ
??? Blastocystis sp.
ÁðïôåëÝóìáôá
1. Áðü ôï óýíïëï ôùí ðåñéóôáôéêþí (ôáêôéêÜ êáé
åðåßãïíôá). ¼ðùò ðñïÝêõøå áðü ôá áñ÷åßá ôïõ åñ-
ãáóôçñßïõ ãéá ôï Ýôïò 2008 äéåíåñãÞèçêáí óõíïëéêÜ
8.553 ãåíéêÝò áßìáôïò, 87.255 âéï÷çìéêÝò åîåôÜóåéò
ðïõ áöïñïýóáí 7.807 Üôïìá, 2.196 ãåíéêÝò ïýñùí,
274 ÷ñüíïé ðñïèñïìâßíçò (INR), 154 êáëëéÝñãåéåò ïý-
ñùí êáé 37 åîåôÜóåéò êïëðéêïý åðé÷ñßóìáôïò. Áíáëõ-
ôéêüôåñá, áðü ôçí êáôáíïìÞ ôçò êßíçóçò ôáêôéêþí êáé
åðåéãüíôùí éáôñåßùí, ïé ðáñáðÜíù åîåôÜóåéò áöï-
ñïýóáí 6.582 áóèåíåßò ðïõ ðñïóÞëèáí ðñïãñáììá-
ôéóìÝíá ãéá áéìáôïëïãéêü Ýëåã÷ï, 6.320 ãéá âéï÷çìéêü
Ýëåã÷ï (75.396 åîåôÜóåéò), åíþ 1.971 áóèåíåßò ðñï-
óÞëèáí åêôÜêôùò ãéá ãåíéêÞ áßìáôïò êáé 1.487 ãéá
åðåßãïõóåò âéï÷çìéêÝò åîåôÜóåéò (11.859 åîåôÜóåéò).
Áðü ôá âéâëßá êßíçóçò ôùí ôáêôéêþí éáôñåßùí êáé
ôïõ éáôñåßïõ åðåéãüíôùí ðåñéóôáôéêþí, êáôÜ ôç äéÜñ-
êåéá ôïõ 2008 êáôáãñÜöçêáí 43.419 Üôïìá ðïõ ðñï-
óÞëèáí óôï ÊÕÉ, áðü ôá ïðïßá 14.997 ðñïóÞëèáí óôï
éáôñåßï åðåéãüíôùí. Óõãêñßíïíôáò ôá ðáñáðÜíù óôïé-
÷åßá ìå ôá áñ÷åßá ôïõ åñãáóôçñßïõ, öáßíåôáé üôé 1
óôïõò 5 (8553/43419) áðü áõôïýò ðïõ ðñïóÞëèáí
Ýêáíáí ÷ñÞóç ôùí õðçñåóéþí ôïõ åñãáóôçñßïõ, Ýóôù
êáé ãéá ìßá áðëÞ ãåíéêÞ áßìáôïò.
ËáìâÜíïíôáò õðüøç üôé ç ôïõñéóôéêÞ ðåñßïäïò
óôçí ðåñéï÷Þ ôçò Âüñåéáò Åýâïéáò áñ÷ßæåé áðü ôï
ÌÜéï êÜèå Ýôïõò êáé ðáñáôåßíåôáé ìÝ÷ñé êáé ôïí Ïêôþ-
âñéï, Ýãéíå áðïôýðùóç ôùí ðñïóåñ÷üìåíùí óå äýï
ðåñéüäïõò (Åéêüíá 2). Áðü ôïí äéá÷ùñéóìü óå ÷åéìå-
ñéíÞ (1/1/2008-30/4/2008 êáé 1/11/2008-31/12/2008)
êáé ôïõñéóôéêÞ ðåñßïäï (1/5/2008-31/10/2008), öÜíç-
êå ç äéðëÜóéá æÞôçóç êáôÜ ôçí ôïõñéóôéêÞ ðåñßïäï óå
êÜèå åßäïò åîÝôáóçò ðïõ ðñáãìáôïðïéåß ôï åñãáóôÞ- 195
ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009
4-ereunitiki.qxd 14/10/2009 2:36 Page 196

Ê. ÁÄÁÌ, Ì. ÈÅÏÄÙÑÏÕ, Ã. ÌÁÍ ÊÁÉ ÓÕÍ.

ñéï, ü÷é ìüíï óôá åðåßãïíôá, áëëÜ êáé óôá ðñïãñáì- êáé óå Üëëá êëéíéêÜ óôïé÷åßá ôïõ áóèåíïýò üðùò çëé-
ìáôéóìÝíá ðåñéóôáôéêÜ. êßá, öýëï êáé éóôïñéêü.
Áðü ôïõò 6.320 áóèåíåßò ðïõ åëÝã÷èçêáí êáôÜ ôï
2. Áðü ðñïãñáììáôéóìÝíá ðåñéóôáôéêÜ. Áðü ôï Ýôïò 2008, óõíïëéêÜ 1.583 Üôïìá (25%) ðñáãìáôï-
óýíïëï ôùí ðáñáðåìðôéêþí, ç ãåíéêÞ áßìáôïò áðïôå- ðïßçóáí âéï÷çìéêü åðáíÝëåã÷ï óôç äéÜñêåéá ôïõ
ëïýóå ôç óõ÷íüôåñá æçôïýìåíç åîÝôáóç (42,3%) êáé Ýôïõò. Áðü áõôïýò, 929 (58,7%) åß÷áí äýï ðáñáðï-
áêïëïõèïýóáí ðáñáðåìðôéêÜ ãéá âéï÷çìéêÝò åîåôÜ- ìðÝò ãéá âéï÷çìéêü Ýëåã÷ï, 426 (26,9%) 3 ðáñáðï-
óåéò (40,6%), ãåíéêÞ ïýñùí (14,1%), ÷ñüíï ðñïèñïì- ìðÝò, 175 (11,1%) 4 ðáñáðïìðÝò, 38 (2,4%) 5
âßíçò (1,8%), êáëëéÝñãåéåò ïýñùí (1%) êáé åîÝôáóç ðáñáðïìðÝò, åíþ ïé õðüëïéðïé 15 (0,9%) ðåñéóóüôå-
êïëðéêïý åðé÷ñßóìáôïò (0,2%). ñåò áðü 5 ðáñáðïìðÝò (Ðßíáêáò 2). Ïé óõ÷íüôåñåò
Áðü ôéò âéï÷çìéêÝò åîåôÜóåéò, ç óõ÷íüôåñç Þôáí åîåôÜóåéò ðåñéëÜìâáíáí Ýíáí ðëÞñç âéï÷çìéêü Ýëåã-
ôï óÜê÷áñï ðïõ æçôÞèçêå óôï 82,7% ôùí ðáñáðå- ÷ï, äçëáäÞ óÜê÷áñï, ïõñßá, êñåáôéíßíç, ëéðßäéá, ïõ-
ìðôéêþí, ç ïõñßá óôï 81,3%, ïé ôñáíóáìéíÜóåò óôï ñéêü ïîý êáé Ýíæõìá (CK, ãGT, SGOT, SGPT, LDH),
80,8%, ç ÷ïëçóôåñßíç êáé ôá ôñéãëõêåñßäéá óôï 80,1% åíþ Ýíá ìéêñü ðïóïóôü áöïñïýóå ìåìïíùìÝíåò åîå-
êáé 79,8% áíôßóôïé÷á, ôï ïõñéêü ïîý óôï 77,7% êáé ïé ôÜóåéò, üðùò Ýëåã÷ï óáê÷Üñïõ, ïõñéêïý ïîÝïò Þ óé-
HDL/LDL óôï 76,7% (Ðßíáêáò 1). äÞñïõ. Óôçí ðëåéïøçößá ôïõò åðñüêåéôï ãéá áóèåíåßò
¼óïí áöïñÜ óôçí áíáãêáéüôçôá ôùí æçôïýìåíùí Üíù ôùí 60 åôþí (1.124 áóèåíåßò, 71%). Ôï ðïóïóôü
åîåôÜóåùí, ôï õøçëüôåñï ðïóïóôü ðáèïëïãéêþí ôé- ôùí ãõíáéêþí Üããéæå ôï 62% (982 ãõíáßêåò), åíþ áõ-
ìþí êáôáãñÜöçêå ãéá ôç ÷ïëçóôåñßíç (60,8%), áêï- ôü ôùí áíäñþí Ýöôáíå ìüëéò ôï 38% (601 Üíäñåò). Óå
ëïõèïýìåíï áðü ôï óÜê÷áñï (22,4%), ôá ü,ôé áöïñÜ óôçí áéôßá ðñïóÝëåõóÞò ôïõò ãéá åðáíÝ-
ôñéãëõêåñßäéá (15,9%), ôï ïõñéêü ïîý (13,9%) êáé ôçí ëåã÷ï, óôçí ðñþôç èÝóç Þôáí ï áðëüò åñãáóôçñéá-
LDL (13,3%) (Ðßíáêáò 1). Ç ýðáñîç ðáèïëïãéêþí áðï- êüò Ýëåã÷ïò (check up) (45,7%) êáé áêïëïõèïýóáí ï
ôåëåóìÜôùí ïëéêÞò ÷ïëçóôåñßíçò êáé LDL äå óõíåðÜ- Ýëåã÷ïò õðåñëéðéäáéìßáò (35%), ï óáê÷áñþäçò äéá-
ãåôáé êáô' áíÜãêç êáé ðáñïõóßá íüóïõ. Ç áðüöáóç âÞôçò (13,8%), ç áíáéìßá (3,1%) êáé ç õðåñïõñé÷áéìßá
ãéá ôï áí êÜðïéïò åßíáé õðåñëéðéäáéìéêüò Þ ü÷é êñßíå- (2,4%).
ôáé áðü ôá êñéôÞñéá ôçò ATP III (Adult Treatment Panel)
ôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáò ôùí ÇÐÁ, ðïõ åõñý- 3. Áðü åðåßãïíôá ðåñéóôáôéêÜ. Áðü ôá ôçñïýìåíá
ôåñá ÷ñçóéìïðïéïýíôáé áðü ôïõò êëéíéêïýò éáôñïýò âéâëßá êßíçóçò ôïõ éáôñåßïõ åðåéãüíôùí ðåñéóôáôéêþí
êáé ðïõ âáóßæïíôáé êõñßùò óôçí ôéìÞ ôçò LDL, áëëÜ êáôÜ ôç äéÜñêåéá ôïõ Ýôïõò 2008 ðñïóÞëèáí Þ ðñïóêï-
ìßóôçêáí óôï ÊÕÉ 14.997 áóèåíåßò. ÁíÜìåóá óôá áßôéá
ðñïóÝëåõóçò îå÷þñéóáí ãéá ôç ÷åéìåñéíÞ ðåñßïäï êáé
Áñéèìüò âéï÷çìéêþí åîåôÜóåùí êáé ðáèïëïãéêþí
áðïôåëåóìÜôùí áðü 6.320 áóèåíåßò ðïõ ðñïóÞëèáí êáôÜ öèßíïõóá óåéñÜ åêäçëþóåéò êáé óõìðôþìáôá áðü
Ðßíáêáò 1 ôï êõêëïöïñéêü (óôçèáã÷éêüò ðüíïò, äýóðíïéá, õðÝñ-
196 ãéá ðñïãñáììáôéóìÝíåò åîåôÜóåéò êáôÜ ôï Ýôïò 2008.
ôáóç) 23,9%, áêïëïýèçóáí óõìðôþìáôá áðü ôï ðåðôé-
Ðïóïóôü (%) Ðïóïóôü (%) êü óýóôçìá (êïéëéáêüò ðüíïò, Ýìåôïé, íáõôßá, äéÜññïéá)
Âéï÷çìéêÝò Áñéèìüò áóèåíþí ðïõ ðáèïëïãéêþí
17,2% êáé ðõñåôüò 15,2%. ÊáôÜ ôçí ôïõñéóôéêÞ ðåñßï-
åîåôÜóåéò åîåôÜóåùí åëÝã÷èçêáí äåéãìÜôùí
äï ç óåéñÜ áíôéóôñÝöåôáé, ìå ðñþôï áßôéï ðñïóÝëåõóçò
ÓÜê÷áñï 5227 82,7 22,4 óõìðôþìáôá áðü ôï ðåðôéêü óýóôçìá (25,2%) êáé áêï-
Ïõñßá 5138 81,3 4,2 ëïýèçóáí óõìðôþìáôá áðü ôï êõêëïöïñéêü (15,4%)
SGOT 5109 80,8 1,1 (Ðßíáêáò 3).
SGPT 5088 80,5 2,1 Áðü ôïõò 14.997 áóèåíåßò, æçôÞèçêå åñãáóôçñéá-
×ïëçóôåñßíç 5061 80,1 60,8
êÞ õðïóôÞñéîç ãéá ôïõò 2.001 áðü áõôïýò (1 óôïõò
Ôñéãëõêåñßäéá 5041 79,8 15,9
7,5 áóèåíåßò). Áíáëõôéêüôåñá, óôïõò 1.971 áðü áõ-
Êñåáôéíßíç 5016 79,4 1,6
ã-GT 5002 79,1 4,1
Ïõñéêü ïîý 4910 77,7 13,9
HDL 4845 76,7 4,5 Óõ÷íüôçôá åðáíåëÝã÷ïõ âéï÷çìéêþí åîåôÜóåùí êáôÜ
LDL 4845 76,7 13,3 Ðßíáêáò 2 ôï Ýôïò 2008.
Óßäçñïò 4477 70,8 7,2
Óõ÷íüôçôá ¢ôïìá Ðïóïóôü (%)
CK 3846 60,9 2,1
åðéóêÝøåùí
LDH 2651 41,9 1,2
Ïë. ÷ïëåñõèñßíç 1705 27,0 3,2 2 929 58,7
¢ì. ÷ïëåñõèñßíç 1705 27,0 2,4 3 426 26,9
Áëê. öùóöáôÜóç 1527 24,2 4,8 4 175 11,1
ÁìõëÜóç 1405 22,2 7,3 5 38 2,4
Ê+ 712 11,3 7,2 >5 15 0,9
Na+ 712 11,3 3,8 Óýíïëï 1583 100

VOL. 54 • ISSUE 4, July - August 2009

4-ereunitiki.qxd 14/10/2009 2:36 Page 197

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????????????ÅÑÃÁÓÔÇÑÉÁÊÇ ÖÑÏÍÔÉÄÁ
??? Blastocystis sp.

Áßôéá ðñïóÝëåõóçò ôùí áóèåíþí óôï ÊÝíôñï Õãåßáò Áñéèìüò âéï÷çìéêþí åîåôÜóåùí êáé ðáèïëïãéêþí áðï-
Ðßíáêáò 3 Éóôéáßáò êáôÜ ôï Ýôïò 2008. ôåëåóìÜôùí áðü 1.487 áóèåíåßò ðïõ ðñïóÞëèáí óôï éá-
Ðßíáêáò 4 ôñåßï åðåéãüíôùí ðåñéóôáôéêþí êáôÜ ôï Ýôïò 2008.
×åéìåñéíÞ ÔïõñéóôéêÞ
Áßôéá ðñïóÝëåõóçò ðåñßïäïò (%) ðåñßïäïò (%) Áñéèìüò Ðïóïóôü (%) Ðïóïóôü (%)
Âéï÷çìéêÝò åîåôÜóåùí êáôÜ áóèåíþí ðïõ ðáèïëïãéêþí
Óõìðôþìáôá áðü ôï êõêëïöïñéêü 23,9 15,4 åîåôÜóåéò óåéñÜ óõ÷íüôçôáò åëÝã÷èçêáí äåéãìÜôùí
Óõìðôþìáôá áðü ôï ðåðôéêü 17,2 25,2
Åìðýñåôï 15,2 4,2 Ïõñßá 1235 83,1 7,0
ÆÜëç-ßëéããïò 5,1 6,7 Êñåáôéíßíç 1235 83,1 5,7
Ïóöõï-éó÷õáëãßá 4,7 5,0 ÓÜê÷áñï 1186 79,8 17,8
Êáêþóåéò 4,6 7,0 SGOT 1042 70,1 5,6
ÅîÜíèçìá 2,4 5,1 SGPT 1042 70,1 4,9
ÄÞãìá åíôüìïõ 1,7 8,2 CK 1032 69,4 5,1
Ôñï÷áßï áôý÷çìá 1,5 3,1 ã-GT 816 54,9 3,8
Áðþëåéá áéóèÞóåùí 1,1 0,8 LDH 749 50,4 3,6
Ê+ 744 50,0 13,2
Na+ 744 50,0 5,2
CK-MB 727 48,9 6,2
ôïýò Ýãéíå ãåíéêÞ áßìáôïò (98,5%), åíþ óôïõò 1.487 Ïë. ÷ïëåñõèñßíç 366 24,6 3,8
(74,3%) äéåíåñãÞèçêáí 11.859 âéï÷çìéêÝò åîåôÜóåéò. ¢ì. ÷ïëåñõèñßíç 366 24,6 1,9
Ï ðñáãìáôéêüò áñéèìüò ôùí ãåíéêþí áßìáôïò åßíáé ìå- ÁìõëÜóç 359 24,1 3,9
ãáëýôåñïò áðü áõôüí ðïõ êáôáãñÜöåôáé óôá áñ÷åßá Áëê. öùóöáôÜóç 216 14,5 5,1
ôïõ åñãáóôçñßïõ, ãéáôß ôïí áéìáôïëïãéêü áíáëõôÞ ÷åé-
ñßæïíôáé êáé ïé áãñïôéêïß éáôñïß, ÷ùñßò üìùò íá êáôá-
ãñÜöïõí ôá ðåñéóôáôéêÜ. Ç ãåíéêÞ åîÝôáóç ïýñùí óåéò - åðåéäÞ äåí åöçìåñåýåé êáèçìåñéíÜ ôï Ìéêñï-
åêôåëåßôáé óôï éáôñåßï åðåéãüíôùí ðåñéóôáôéêþí áðü âéïëïãéêü åñãáóôÞñéï.
ôïõò áãñïôéêïýò éáôñïýò ìå ôç ÷ñÞóç ôùí åéäéêþí Ïé ðéï óõ÷íÜ æçôïýìåíåò åîåôÜóåéò áðü ôï âéï÷ç-
ôáéíéþí (strips), ãé' áõôü êáé äåí ðåñéëáìâÜíåôáé óôï ìéêü Ýëåã÷ï Þôáí ç ïõñßá-êñåáôéíßíç óôï 83,1% ôùí
åßäïò ôùí æçôïýìåíùí åîåôÜóåùí áðü ôï åñãáóôÞñéï áóèåíþí, ôï óÜê÷áñï êáé ôá çðáôéêÜ Ýíæõìá óôï
êáôÜ ôçí åöçìåñßá. 79,8% êáé 70,1% ôùí áóèåíþí áíôßóôïé÷á, åíþ ïé çëå-
Áðü ôçí áðïôýðùóç óå éóôüãñáììá ôïõ áñéèìïý êôñïëýôåò æçôÞèçêáí ìüëéò óôï 50% ôùí ðñïóåëèü-
ôùí Ýêôáêôùí ðáñáðåìðôéêþí áíÜ ìÞíá, ðñïÝêõøå íôùí (Ðßíáêáò 4). ¼óïí áöïñÜ óôçí áíáãêáéüôçôá
ìßá áýîçóç óôï äéðëÜóéï ôçò ðñïóÝëåõóçò ôùí ôùí æçôïýìåíùí åîåôÜóåùí, ôï õøçëüôåñï ðïóïóôü
áóèåíþí êáôÜ ôïõò ìÞíåò Éïýëéï êáé Áýãïõóôï, ïðü- ðáèïëïãéêþí ôéìþí êáôáãñÜöçêå ãéá ôï óÜê÷áñï 197
ôå êáé êïñõöþíåôáé ç ôïõñéóôéêÞ ðåñßïäïò ôçò ðå- (17,8%), áêïëïõèïýìåíï áðü ôï Ê+ (13,2%). Ç ôñï-
ñéï÷Þò (Åéêüíá 3). Èá ðñÝðåé íá ôïíéóèåß üôé ï ðïíßíç ðïõ ãßíåôáé óôï éáôñåßï åðåéãüíôùí ìå ðïéïôé-
ðñáãìáôéêüò áñéèìüò åðåéãüíôùí ðáñáðåìðôéêþí åß- êü ðñïóäéïñéóìü, üôáí äåí õðÜñ÷åé åñãáóôçñéáêÞ
íáé õðïôéìçìÝíïò - éäéáßôåñá óôéò âéï÷çìéêÝò åîåôÜ- õðïóôÞñéîç, öáßíåôáé íá ìåßùóå ôç æÞôçóç ôçò CK-

Åéêüíá 3. Áñéèìüò ðáñáðåìðôéêþí

åðåéãüíôùí ðåñéóôáôé-
êþí áíÜ ìÞíá ôïõ Ýôïõò
2008.

ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009

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Ê. ÁÄÁÌ, Ì. ÈÅÏÄÙÑÏÕ, Ã. ÌÁÍ ÊÁÉ ÓÕÍ.
MB êáé Üñá êáé ôï ðïóïóôü ôùí ðáèïëïãéêþí äåéãìÜ-
ôùí ãéá ôï Ýíæõìï áõôü.
ÓõæÞôçóç
Ôï Ìéêñïâéïëïãéêü åñãáóôÞñéï áðïôåëåß âáóéêü õðï-
óôçñéêôéêü êïñìü ôïõ ÊÕÉ. Áí êáé ôï öÜóìá ôùí åêôå-
ëïýìåíùí åîåôÜóåùí åßíáé ìéêñü, ôï åñãáóôÞñéï
áíôéìåôùðßæåé Ýíá ìåãÜëï áñéèìü æçôïýìåíùí åîåôÜ-
óåùí, üðùò áðïäåß÷èçêå áðü ôçí ðáñïýóá åñãáóßá
ìáò. ÊáôÜ ôç äéÜñêåéá ôïõ Ýôïõò 2008 ðñáãìáôïðïé-
Þèçêáí 98.469 åîåôÜóåéò áðü ôéò ïðïßåò 88,6% áöï-
ñïýóå âéï÷çìéêü Ýëåã÷ï, 8,7% áðëü áéìáôïëïãéêü
Ýëåã÷ï êáé 2,7% ðåñéëÜìâáíå áðëÝò ãåíéêÝò êáé êáë-
ëéÝñãåéåò ïýñùí, ÷ñüíï ðñïèñïìâßíçò êáé åîÝôáóç
êïëðéêïý åðé÷ñßóìáôïò.
ÊáôÜ ôçí ôïõñéóôéêÞ ðåñßïäï, ç ïðïßá óôçí ðåñéï÷Þ
åõèýíçò ôïõ ÊÕÉ áñ÷ßæåé áðü ôïí ÌÜéï êáé ïëïêëçñþíå-
ôáé ôïí Ïêôþâñéï, äéáðéóôþèçêå äéðëÜóéá æÞôçóç óå
üëá ôá åßäç ôùí ìéêñïâéïëïãéêþí åîåôÜóåùí, ôüóï óôá
åðåßãïíôá, üóï êáé óôá ðñïãñáììáôéóìÝíá ðåñéóôáôéêÜ.
Ôï ãåãïíüò áõôü äéêáéïëïãåßôáé, üðùò Üëëùóôå êáé ïé
ßäéïé ïé ðñïóåñ÷üìåíïé ïìïëïãïýí, áðü ôçí ôá÷ýôåñç
ðñüóâáóç óôéò õðçñåóßåò õãåßáò ðïõ áðïëáìâÜíïõí
(÷ñüíïò áíáìïíÞò ãéá ñáíôåâïý, ÷ñüíïò ðáñáëáâÞò
áðïôåëåóìÜôùí) óå ó÷Ýóç ìå ôá áóôéêÜ êÝíôñá áðü ôá
ïðïßá ðñïÝñ÷ïíôáé. ÊáôÜ óõíÝðåéá, ç ðïéüôçôá ôùí
ðñïóöåñüìåíùí õðçñåóéþí êáèéóôïýí ôï ÊÕÉ óçìáíôé-
êü ðáñÜãïíôá ãéá ôçí ôïõñéóôéêÞ áíÜðôõîç ôçò ðåñéï-
÷Þò. Áîßæåé íá óçìåéùèåß üôé, åíþ ç åðéóêåøéìüôçôá óôï
Ìéêñïâéïëïãéêü åñãáóôÞñéï äéðëáóéÜæåôáé, ôï ðñïóù-
ðéêü ðáñáìÝíåé ôï ßäéï êáé ìÜëéóôá ÷ùñßò íá êÜíåé ÷ñÞ-
óç ôçò êáíïíéêÞò ôïõ Üäåéáò ôïõò äýï êáëïêáéñéíïýò
198
ìÞíåò Éïýëéï êáé Áýãïõóôï, ïðüôå êáé êïñõöþíåôáé ç
ôïõñéóôéêÞ êßíçóç, ðñïêåéìÝíïõ íá åßíáé áðñüóêïðôç ç
ðáñï÷Þ åñãáóôçñéáêÞò õðïóôÞñéîçò óôïí ðëçèõóìü
ôçò ðåñéï÷Þò.
¼ðùò äéáðéóôþèçêå áðü ôçí ëåðôïìåñÞ áíÜëõóç
ôùí åîåôÜóåùí ðïõ æçôÞèçêáí óôá ðñïãñáììáôéóìÝ-
íá ðåñéóôáôéêÜ, ôá êëéíéêÜ áßôéá äå öáßíåôáé íá åßíáé ç
âáóéêÞ ðáñÜìåôñïò óôçí åðéëïãÞ ôùí æçôïýìåíùí
åîåôÜóåùí. Ôá ÐÉ, áðü ôá ïðïßá ðñïÝñ÷ïíôáé óôçí
ðëåéïøçößá ôïõò ôá ðñïãñáììáôéóìÝíá ðåñéóôáôéêÜ,
óôåëå÷þíïíôáé áðïêëåéóôéêÜ áðü áãñïôéêïýò éáôñïýò.
Ç Ýëëåéøç êëéíéêÞò åìðåéñßáò ôïõò, áëëÜ êáé ç áðïõóßá
åéäéêþí ãåíéêþí éáôñþí Ý÷ïõí óáí áðïôÝëåóìá ôá ðá-
ñáðåìðôéêÜ íá êáôáëÞãïõí óôï åñãáóôÞñéï ÷ùñßò êëé-
íéêÝò ðëçñïöïñßåò ìå ðëçèþñá áäéêáéïëüãçôùí,
ðïëëÝò öïñÝò, åîåôÜóåùí.
¼óïí áöïñÜ óôç óõ÷íüôçôá åðáíåëÝã÷ïõ ôùí
âéï÷çìéêþí áðïôåëåóìÜôùí, áðïäåéêíýåôáé üôé óõ÷íÜ
ãßíåôáé êáôÜ÷ñçóç ôùí õðçñåóéþí ôïõ åñãáóôçñßïõ,
êõñßùò áðü çëéêéùìÝíá Üôïìá, êáé éäéáßôåñá ãõíáßêåò,
êáèþò åðáíáëáìâÜíïíôáé âéï÷çìéêÝò åîåôÜóåéò, ðïë-
ëÝò öïñÝò äß÷ùò óõãêåêñéìÝíç áéôßá. Åðéðñüóèåôá,
áðü ôçí ðáñïýóá ìåëÝôç äéáðéóôþíåôáé, üôé óõ÷íÜ æç-
VOL. 54 • ISSUE 4, July - August 2009
ôåßôáé éäéáßôåñá ìåãÜëïò áñéèìüò åîåôÜóåùí, åíþ ôá
áíôßóôïé÷á ðáèïëïãéêÜ åõñÞìáôá åßíáé óçìáíôéêÜ
öôù÷Ü. ÁðïôÝëåóìá áõôÞò ôçò Üóêïðçò æÞôçóçò åñ-
ãáóôçñéáêþí åîåôÜóåùí åßíáé, ôüóï ç áýîçóç ôïõ êü-
óôïõò ëåéôïõñãßáò ôïõ åñãáóôçñßïõ, üóï êáé ç
åðéâÜñõíóÞ ôïõ, ãåãïíüò ðïõ óõíåðÜãåôáé äõó÷Ý-
ñåéá óôç äõíáôüôçôá ôá÷ýôåñçò êáé áðïôåëåóìáôéêÞò
ðáñï÷Þò õðçñåóéþí õãåßáò áðü ôï åñãáóôÞñéï óôïõò
áóèåíåßò, ðïõ ðñáãìáôéêÜ Ý÷ïõí áíÜãêç.
ÔÝëïò áðü ôçí áîéïëüãçóç ôïõ åßäïõò êáé ôïõ áñéè-
ìïý ôùí åîåôÜóåùí ðïõ æçôÞèçêáí êáôÜ ôçí åöçìåñßá,
üðùò ðñïÝêõøå áðü ôá ÷áìçëÜ ðïóïóôÜ ðáèïëïãéêþí
áðïôåëåóìÜôùí, ï áñéèìüò ôùí æçôïýìåíùí åîåôÜóå-
ùí áðü ôï éáôñåßï åðåéãüíôùí ðåñéóôáôéêþí êñßíåôáé
õðåñâïëéêüò êáé áõîÜíåé ôï êüóôïò ëåéôïõñãßáò ôïõ
åñãáóôçñßïõ. Ôï öáéíüìåíï ôçò õðåñâïëéêÞò æÞôçóçò,
êõñßùò âéï÷çìéêþí åîåôÜóåùí, ÷ùñßò êáíÝíá äéáãíù-
óôéêü ðñïóáíáôïëéóìü, ðáñáôçñÞèçêå óôá ðáñáðå-
ìðôéêÜ ðïõ õðïãñÜöïíôáí áðü áãñïôéêïýò éáôñïýò,
éäßùò üôáí êáëïýíôáí íá äéåêðåñáéþóïõí ôçí åöçìå-
ñßá, áðïõóßá åéäéêïý éáôñïý. ÁëëÜ êáé ï åéäéêüò éáôñüò
êáëåßôáé íá åöçìåñåýóåé õðü ôçí Ýëëåéøç Üëëùí åñãá-
óôçñéáêþí åéäéêïôÞôùí, ìÝóá óå Ýíá êëßìá áíáóöÜ-
ëåéáò, ðïõ äçìéïõñãåßôáé áðü Üäéêåò äçìïóéïãñáöéêÝò
- åéóáããåëéêÝò êáôáããåëßåò, ãåãïíüò ðïõ óõìâÜëëåé
óôçí áõîçìÝíç æÞôçóç ìéêñïâéïëïãéêþí åîåôÜóåùí.
Ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ìáò ìðïñïýí íá åîç-
ãçèïýí êáé äåí åßíáé ðñùôïöáíÞ êáé ìïíáäéêÜ óôçí åë-
ëçíéêÞ åðéêñÜôåéá.8,9 Ïé ðëçèõóìéáêÝò éäéáéôåñüôçôåò
ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÕÉ (ãçñéáôñéêüò, ïéêïíïìé-
êïß ìåôáíÜóôåò ðïõ ïäçãïýí óå áýîçóç ôçò íïóçñü-
ôçôáò, äéáèÝóéìï åéóüäçìá, êïéíùíéêïïéêïíïìéêü êáé
åêðáéäåõôéêü åðßðåäï), óå óõíäõáóìü ìå ôç ãåùãñá-
ößá ôçò ðåñéï÷Þò, ðïõ äåí äéåõêïëýíåé ôçí Üìåóç ðñü-
óâáóç óå íïóïêïìåßï (ôï ðëçóéÝóôåñï âñßóêåôáé óå
áðüóôáóç 2 ùñþí ìå ôï áóèåíïöüñï), ïäçãïýí óå áõ-
îçìÝíç æÞôçóç õðçñåóéþí õãåßáò. Åîáéôßáò áêñéâþò
áõôÞò ôçò ãåùãñáöéêÞò áðïìüíùóçò ç ðïëéôåßá, áëëÜ
êõñßùò ïé áíÜãêåò ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÕÉ, õðï-
÷ñåþíïõí ôçí åöáñìïãÞ ÄåõôåñïâÜèìéáò ðåñßèáëøçò
ìå ôá ìÝóá, ôéò õðïäïìÝò êáé ôç óôåëÝ÷ùóç ôçò Ðñù-
ôïâÜèìéáò ðåñßèáëøçò.
Åîáéôßáò ôçò åõñýôáôçò äéÜäïóçò ôçò áóöÜëéóçò
õãåßáò, áëëÜ êáé ôçò äùñåÜí ðáñï÷Þò ôùí õðçñåóéþí
õãåßáò áðü ôçí ÐÖÕ, ï áóèåíÞò, ùò Üìåóïò êáôáíá-
ëùôÞò, äåí õðüêåéôáé óå êÜðïéï êüóôïò áðü ôç ÷ñÞóç
ôùí õðçñåóéþí õãåßáò, ìå áðïôÝëåóìá ôçí ðñïêëçôÞ
êáôáíÜëùóç åñãáóôçñéáêþí åîåôÜóåùí, ôéò ïðïßåò
ïöåßëåé íá äéåêðåñáéþóåé ôï åñãáóôÞñéï. Áðü ôçí Üë-
ëç ìåñéÜ, ï êëéíéêüò éáôñüò, ùò Ýììåóïò êáôáíáëù-
ôÞò, ðïõ äåí ðëçñþíåé áõôüò ôéò õðçñåóßåò åíüò
åñãáóôçñßïõ, äýíáôáé íá äçìéïõñãÞóåé öáéíüìåíá
ðñïêëçôÞò æÞôçóçò.10,11 ÅðéðëÝïí, ï éáôñéêüò öÜêå-
ëïò (Ýíôõðïò Þ çëåêôñïíéêüò), óôïé÷åßï âáóéêü ãéá ôç
óõíÝ÷éóç ôçò ðáñáêïëïýèçóçò ôïõ áóèåíïýò äåí ôç-
ñåßôáé, ðáñÜ ìüíï áðü åëÜ÷éóôïõò êëéíéêïýò éáôñïýò,
4-ereunitiki.qxd 14/10/2009 2:36 Page 199

?????? ?????? ???????? ???? ???????ÐÑÙÔÏÂÁÈÌÉÁ

????????????ÅÑÃÁÓÔÇÑÉÁÊÇ ÖÑÏÍÔÉÄÁ
??? Blastocystis sp.

ìå áðïôÝëåóìá ôçí Üêñéôç äéåíÝñãåéá ìéêñïâéïëïãé-
êþí åîåôÜóåùí êáé ìÜëéóôá ðïëëÝò öïñÝò êáô' åðéèõ-
ìßá Þ/êáé åðéìïíÞ ôïõ ßäéïõ ôïõ áóèåíïýò.12 Ç
ëåéôïõñãßá åîåéäéêåõìÝíùí éáôñåßùí (õðåñôáóéïëïãé-
êïý, äéáâçôïëïãéêïý, õðåñëéðéäáéìßáò) ìå ôç óôåëÝ-
÷ùóç ôïõ ÊÝíôñïõ Õãåßáò áðü éáôñïýò áíôßóôïé÷ùí
åéäéêïôÞôùí èá ðåñéüñéæå ôçí Üóêïðç äéåíÝñãåéá ìé-
êñïâéïëïãéêþí åîåôÜóåùí ìå Üìåóç åðßðôùóç óôç
ìåßùóç ôïõ êüóôïõò ëåéôïõñãßáò ôïõ åñãáóôçñßïõ,
áëëÜ êáé óôïí åìðëïõôéóìü ôïõ ìå íÝåò åîåôÜóåéò, ãå-
ãïíüò ðïõ åßíáé áðáãïñåõôéêü õðü ôéò ðáñïýóåò óõí-
èÞêåò ëåéôïõñãßáò ôïõ.13,14
Ç ìåãÜëç ðñüïäïò ðïõ óçìåéþèçêå ôéò ôåëåõôáß-
åò äåêáåôßåò óôçí éáôñéêÞ êáé óôçí ôå÷íïëïãßá, ïäÞ-
ãçóå óôçí áíÜðôõîç ôçò åñãáóôçñéáêÞò éáôñéêÞò, ìå
ôç ÷ñçóéìïðïßçóç íÝùí óõóêåõþí êáé ïñãÜíùí êáé
ôçí åéóáãùãÞ íÝùí åîåôÜóåùí êáé ìåèüäùí.15 Ç áíÜ-
ðôõîç êáé åöáñìïãÞ ôçò âéïúáôñéêÞò ôå÷íïëïãßáò óôï
÷þñï ôùí åñãáóôçñßùí ôá ôåëåõôáßá ÷ñüíéá Þôáí
ðñÜãìáôé åíôõðùóéáêÞ, êáé åß÷å ùò áðïôÝëåóìá ôçí
áýîçóç ôçò óðïõäáéüôçôáò ôçò åñãáóôçñéáêÞò åîÝ-
ôáóçò ôüóï ãéá ôï äéáãíùóôéêü, üóï êáé ôï èåñáðåõ-
ôéêü áðïôÝëåóìá, Ýíáíôé ôçò êëéíéêÞò ðáñáôÞñçóçò.16
ÐáñÜëëçëá ç óõíå÷éæüìåíç åêðáßäåõóç ôùí éá-
ôñþí ôçò ÐÖÕ öáßíåôáé íá õóôåñåß Ýíáíôé ôùí íïóïêï-
ìåéáêþí éáôñþí. ÏñãáíùìÝíá ðñïãñÜììáôá
êáôÜñôéóçò êáé óõíå÷éæüìåíçò åêðáßäåõóçò óôá áíôé-
êåßìåíá ôçò ÐÖÕ êáé ôçò äçìüóéáò õãåßáò åßíáé áíý-
ðáñêôá, åíþ êÜðïéá ìáèÞìáôá äéïñãáíþíïíôáé áðü
öáñìáêåõôéêÝò åôáéñåßåò.17 Èá ðñÝðåé ðñïöáíþò íá
áíáôñÝîåé êáíåßò óôá ðñïðôõ÷éáêÜ ÷ñüíéá êáé óôçí
áíáäéïñãÜíùóç ôùí éáôñéêþí óðïõäþí, ðñïêåéìÝíïõ
íá êáëõöèïýí ïé áäõíáìßåò ðáñáãùãÞò åðéóôçìüíùí
ìå åôïéìüôçôá êáé êáôáëëçëüôçôá ðñïóáñìïãÞò óôï
Üìåóï åñãáóéáêü ðåñéâÜëëïí. ¢ëëùóôå, Ýíá ôÝôïéï
ðåñéâÜëëïí áðïôåëåß áõôü ôçò ÐÖÕ, êáèþò üëïé ïé
áðüöïéôïé ôçò ÉáôñéêÞò Ó÷ïëÞò êáëïýíôáé íá åêðëç-
ñþóïõí ôçí õðï÷ñåùôéêÞ õðçñåóßá õðáßèñïõ ìåôÜ ôç
ëÞøç ôïõ ðôõ÷ßïõ ôïõò.
ÐÝñáí ôçò êáôÜñôéóçò ðñïãñáììÜôùí åêðáßäåõ-
óçò ôùí éáôñþí ôçò ÐÖÕ êáé ìå äåäïìÝíï üôé ïé ðåñéó-
óüôåñïé êëéíéêïß éáôñïß áóêïýí áìõíôéêÞ éáôñéêÞ,
ðáñáããÝëíïíôáò üóï ôï äõíáôüí ðåñéóóüôåñåò åñ-
ãáóôçñéáêÝò åîåôÜóåéò, ðñïêåéìÝíïõ íá áõôïðñïóôá-
ôåõèïýí êáé íá áðïöýãïõí ôéò åõèýíåò ëáíèáóìÝíçò
äéÜãíùóçò, èá ðñÝðåé íá ëçöèïýí ìÝôñá þóôå íá ðå-
ñéïñéóôåß äñáóôéêÜ ç ðñïêëçôÞ éáôñïãåíÞò æÞôçóç
åñãáóôçñéáêþí åîåôÜóåùí. ÔÝôïéá ìÝôñá áðïôåëïýí
ç åõáéóèçôïðïßçóç ôïõ éáôñéêïý äõíáìéêïý óå æçôÞ-
ìáôá êüóôïõò êáé ç ðáñáðïìðÞ åñãáóôçñéáêþí åîå-
ôÜóåùí ýóôåñá áðü åìðåñéóôáôùìÝíç êëéíéêÞ
åêôßìçóç åéäéêåõìÝíïõ éáôñïý.9
Áîßæåé üìùò íá ôïíéóôåß üôé, ðáñÜ ôá åõñÞìáôá ôçò
åñãáóßáò ìáò, ýóôåñá áðü ôéò åðßìïíåò êáé åðáíåé-
ëçììÝíåò åðéóçìÜíóåéò áðü ìÝñïõò ôïõ åñãáóôç-
ñßïõ, Þôáí öáíåñÞ ìéá áëëáãÞ óôçí ôáêôéêÞ ôùí
åéäéêþí êáé ôùí áãñïôéêþí éáôñþí, ùò ðñïò ôç æÞôç-
óç åñãáóôçñéáêþí åîåôÜóåùí, êáôÜ ôç ÷ñïíéêÞ ðå-
ñßïäï ðïõ áêïëïýèçóå ôçí Ýñåõíá. Ôï ãåãïíüò áõôü
áðïäåéêíýåé ôçí åðéôáêôéêÞ áíÜãêç ðáñïõóßáò ôïõ åé-
äéêïý Âéïðáèïëüãïõ óôç óôåëÝ÷ùóç ôùí ÊÝíôñùí
Õãåßáò, êáé ü÷é áðëÜ ôçí åãêáôÜóôáóç äýï áíáëõôþí
(âéï÷çìéêïý êáé áéìáôïëïãéêïý õðü ôçí åõèýíç ôå÷íï-
ëüãïõ Þ áãñïôéêïý éáôñïý), üðùò óõíÞèùò óõìâáß-
íåé óôçí ðëåéïøçößá ôùí ÊÝíôñùí Õãåßáò ôçò
åðéêñÜôåéáò. Ï åéäéêüò Âéïðáèïëüãïò ìå ôéò ãíþóåéò
êáé ôçí åìðåéñßá ôïõ ìðïñåß, óå óõíåñãáóßá ìå ôïõò
êëéíéêïýò éáôñïýò, íá êáôåõèýíåé óôçí ïñèïëïãéêÞ
÷ñÞóç ôùí õðçñåóéþí õãåßáò ôïõ åñãáóôçñßïõ êáé
ðáñÜëëçëá íá óõìâÜëëåé óôïí ðåñéïñéóìü ôùí äáðá- 199
íþí ôïõ, ðñïò üöåëïò ðÜíôá ôïõ ðëçèõóìïý åõèý-
íçò ôïõ ÊÝíôñïõ Õãåßáò, áëëÜ êáé ôïõ åõñýôåñïõ
êïéíùíéêïý óõíüëïõ, ðåñéïñßæïíôáò ôçí Üóêïðç áý-
îçóç ôùí äçìüóéùí äáðáíþí ãéá ôçí õãåßá.

Summary

The microbiology laboratory services in a primary Health Care Centre

K. Adam, M. Theodorou, G. Man, N. Katsoulis, A. Nikoleri, P. Gabriel

Microbiology Laboratory, Health Centre of Istiaia, General Hospital of Halkida, Istiaia, Greece

Primary Health Care is the basis of the National Health System bringing health care services as clo-
se as possible to the areas where people live and work. In Greece, Primary Health Care offers servi-
ces concerning the prevention, diagnosis and treatment of diseases, y for patients not needing
hospitalization, and it is provided by the general practitioners, the NHS Health Care Centers, the ho-

ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009

4-ereunitiki.qxd 14/10/2009 2:36 Page 200

Ê. ÁÄÁÌ, Ì. ÈÅÏÄÙÑÏÕ, Ã. ÌÁÍ ÊÁÉ ÓÕÍ.

spital outpatients' departments, the health insurance surgeries and the community surgeries. The
aim of the present study was the realistic description of the laboratory services offered by the Health
Center of Histiaia (Evoia, Greece) through a thorough recording of all the diagnostic tests provided
by its Microbiology Laboratory. This study was based on the records of 9,048 individuals who visi-
ted the Istiaia Health Centre and were referred to the Microbiology Lab after being examined in a
scheduled or an emergency surgery. Despite the fact that the variety of diagnostic tests offered by
the Microbiology Lab is limited, during the year 2008 this laboratory handled requests for 98,469
tests. It was observed that during the summer months due to increased numbers of tourists visiting
the area, the demand for microbiological tests requested by both the emergency and scheduled
surgeries was duplicated. Also, it was noted that the request for laboratory tests was not always ba-
sed on the clinical findings and were not always requested by the proper consultant. A large num-
ber of the requested tests were asked for unimportant pathological findings, thus unnecessarily
increasing the functional costs of the Microbiology laboratory requently, no expert consultant had
checked the requested tests, there were scarce or no data concerning the clinical findings and the
majority were signed by community clinic doctors. This study shows the important role of the Micro-
biology laboratory within a Health Centre. The presence of a specialized MD- Biopathologist, colla-
borating well with the clinical doctors, is of outmost importance for the rational use and function of
the Microbiology laboratory and it will benefit the population served by the Health Centre.

Key words
Primary Health Care, Health Care Centre, Mi-
crobiology Laboratory, Medical Biopathology.

Âéâëéïãñáößá
1. Ôïýíôáò Ã. Êïéíùíßá êáé Õãåßá. Óôï: ÍÝá Õãåßá, Åêäüóåéò Ïäõó-
óÝáò, ÁèÞíá, 2000, 26-40.
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âÜèìéáò Öñïíôßäáò Õãåßáò. Óôï: Ç ÐïëéôéêÞ Õãåßá óôçí ÅëëÜäá:
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äçò Ä, Óïýñëá Å êáé óõí. ÌåëÝôç óõ÷íüôçôáò êáé áíáãêáéüôçôáò
ôùí æçôïõìÝíùí ìéêñïâéïëïãéêþí åîåôÜóåùí óôçí ðñùôïâÜèìéá
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Éóüôçôá, áðïôåëåóìáôéêüôçôá êáé áðïäïôéêüôçôá óôéò õðçñåóßåò
õãåßáò. Á. Äüëãåñáò êáé Ã. Êõñéüðïõëïò. Åêäüóåéò ÈåìÝëéï,
ÁèÞíá, 2000, 65-78.
14. ÍÜíïò Ð. ÁæÞôçôåò ÅñãáóôçñéáêÝò ÅîåôÜóåéò: ÐñïêëçôÞ ÆÞôç-
óç Þ ÐñïâëçìáôéêÞ ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Óôï: ÄéÜëï-
ãïé ãéá ôï Íïóïêïìåéáêü management. Ã. ÓôÜèçò. ÐñáêôéêÜ ôïõ
1ïõ ÐáíåëëÞíéïõ Åðéóôçìïíéêïý Óõíåäñßïõ, åêäïôéêÞ óåéñÜ,
ÅðéóôÞìåò Äéïßêçóçò êáé Ïéêïíïìßáò ôçò Õãåßáò, ÁèÞíá, 2000,
218-220.
15. ÌáíéáäÜêçò Í, ÖñáãêïõëÜêçò Â, ÐñåæåñÜêïò Ð. Óýãêñéóç êü-
óôïõò íÝùí ôå÷íïëïãéþí óôçí õãåßá. Êïéíùíßá, Ïéêïíïìßá êáé
Õãåßá 2007; 5: 92-106.
16. ÓéãÜëáò É. Ç óõìâïëÞ ôçò ëåéôïõñãßáò ôùí êëéíéêþí åñãáóôçñßùí
óôçí áðïôåëåóìáôéêüôçôá ôïõ íïóïêïìåßïõ. Åðéèåþñçóç Õãåßáò
1996, 260-264.
17. Ìðïóôáíßôçò É êáé Ôóáëßäïõ Ì. Ç ÐñùôïâÜèìéá Öñïíôßäá
Õãåßáò óôç ÅëëÜäá áðü ôç Ìåôáðïëßôåõóç ìÝ÷ñé ÓÞìåñá. Åðéèå-
þñçóç Õãåßáò 2008; 19(114): 18-22.

VOL. 54 • ISSUE 4, July - August 2009

5-ereunitiki.qxd 14/10/2009 2:38 Page 201

ÅñåõíçôéêÞ Åñãáóßá

ÌåëÝôç ôçò ìéêñïâéáêÞò öïñåßáò ôùí áóèåíþí ìïíÜäáò åíôáôéêÞò

èåñáðåßáò êáé ç óõìâïëÞ ôçò óôçí áíôéìåôþðéóç ôùí ëïéìþîåùí

×. Ôñéêáëéþôçò1, Â. Óïõëïýíôæç2, Å. Êáôóßöá1, Å. Ôóïñëßíç1, Ì. ÌðéôæéÜíç2, Ì. ÂáãéùíÜ3

1Ìéêñïâéïëïãéêü ÅñãáóôÞñéï, Ã.Ð.Í. "Ã. ÐáðáíéêïëÜïõ", Èåóóáëïíßêç
2Á´ÌïíÜäá ÅíôáôéêÞò Èåñáðåßáò, Ã.Ð.Í. "Ã. ÐáðáíéêïëÜïõ" Èåóóáëïíßêç
3ÅñãáóôÞñéï ÕãéåéíÞò Ó÷ïëÞò Åðéóôçìþí Õãåßáò, Éáôñéêü ÔìÞìá, ÁñéóôïôÝëåéï ÐáíåðéóôÞìéï Èåóóáëïíßêçò, Èåóóáëïíßêç

Ðåñßëçøç
201

Óêïðüò ôçò ðáñïýóáò åñãáóßáò åßíáé ç êáëýôåñç êáôáíüçóç ôçò åðéäçìéïëïãßáò ôùí ëïéìþîåùí
ðïõ åìöáíßæïíôáé óôç ìïíÜäá åíôáôéêÞò èåñáðåßáò (ÌÅÈ) ìå ôç âïÞèåéá ìéáò åíáëëáêôéêÞò ôáîéíü-
ìçóçò ðïõ ðñïôåßíåôáé. Ç ôáîéíüìçóç áõôÞ äéáêñßíåé ôéò ëïéìþîåéò óå ðñùôïãåíåßò åíäïãåíåßò, äåõ-
ôåñïãåíåßò åíäïãåíåßò êáé åîùãåíåßò, êáé óôçñßæåôáé óôç ìåëÝôç ôçò öïñåßáò ôùí áóèåíþí êáôÜ ôç
äéÜñêåéá ôçò ðáñáìïíÞò ôïõò óôç ÌÅÈ. Ôï õëéêü ôçò ðáñïýóáò ìåëÝôçò ðñïÞëèå áðü áóèåíåßò ôçò
Á´ ÌÅÈ ôïõ Ãåíéêïý Íïóïêïìåßïõ "Ã. ÐáðáíéêïëÜïõ" ðïõ íïóçëåýôçêáí óôï äéÜóôçìá 2005-2007
êáé ïé ïðïßïé äåí ðñïÝñ÷ïíôáí áðü Üëëç êëéíéêÞ ôïõ íïóïêïìåßïõ Þ áðü êÜðïéï Üëëï íïóçëåõôéêü
ßäñõìá. Óôïõò õðü ìåëÝôç áóèåíåßò Ýãéíå ëÞøç êáé êáëëéÝñãåéá åðé÷ñéóìÜôùí áðü ôï öÜñõããá êáé
ôï ðåñßíåï êáôÜ ôçí åéóáãùãÞ ôïõò óôç ÌÅÈ êáé ìåôÜ áíÜ 3Þìåñï êáôÜ ôç äéÜñêåéá ôçò íïóçëåß-
áò ôïõò. ÐáñÜëëçëá, åðß õðïøßáò ëïéìþîåùí, ãßíïíôáí äéáãíùóôéêÝò êáëëéÝñãåéåò êëéíéêþí äåéãìÜ-
ôùí ôùí áóèåíþí (áßìá, ïýñá, ðôýåëá, âñïã÷éêÝò åêêñßóåéò, âñïã÷ïêõøåëéäéêÜ åêðëýìáôá, ðýïí).
ÓõíïëéêÜ ìåëåôÞèçêáí 96 áóèåíåßò ðïõ íïóçëåýôçêáí óôç ÌÅÈ. Óå 31 áðü áõôïýò áíáðôý÷èçêáí
óõíïëéêÜ 78 ëïéìþîåéò. Ìå âÜóç ôçí ôáîéíüìçóç ðïõ ðñïôåßíåôáé, ïé 28 áðü áõôÝò ôéò ëïéìþîåéò Þôáí
ðñùôïãåíåßò åíäïãåíåßò (33,3%), ïé 34 äåõôåñïãåíåßò åíäïãåíåßò (43,6%) êáé ïé 18 åîùãåíåßò
(23,1%). Óýìöùíá ìå ôï êñéôÞñéï ôùí 48 ùñþí, ðïõ áíáöÝñåé ôï Centre for Disease and Control, ïé
íïóïêïìåéáêÝò ëïéìþîåéò èá õðïëïãßæïíôáí óå 63 (80,8%), åíþ ïé åîùíïóïêïìåéáêÝò óå 15 (19,2%).
Ìå âÜóç üìùò ôï êñéôÞñéï ôçò öïñåßá ôáîéíïìÞèçêáí ùò íïóïêïìåéáêÝò 11 ëéãüôåñåò ëïéìþîåéò
(ðïóïóôü 14,1%). Ïé óõ÷íüôåñïé ìéêñïïñãáíéóìïß Þôáí Acinetobacter baumanii (29,5%) êáé Coagula-
se Negative Staphylococci (26,9%). ÓõìðåñáóìáôéêÜ, ç êáôçãïñéïðïßçóç ôùí ëïéìþîåùí óýìöùíá
ìå ôçí êáôÜóôáóç öïñåßáò ôùí áóèåíþí êÜíåé äõíáôÞ ôçí åê ôùí ðñïôÝñùí ãíþóç ôçò ðéèáíÞò
ðñïÝëåõóçò ôùí ìéêñïïñãáíéóìþí ðïõ ðñïêáëïýí ôç ëïßìùîç. Ç ôáîéíüìçóç áõôÞ ìðïñåß íá âï-

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
5-ereunitiki.qxd 14/10/2009 2:38 Page 202
×. ÔÑÉÊÁËÉÙÔÇÓ, Â. ÓÏÕËÏÕÍÔÆÇ, Å. ÊÁÔÓÉÖÁ ÊÁÉ ÓÕÍ.
çèÞóåé, þóôå ïé åíäå÷üìåíåò ëïéìþîåéò óôç ÌÅÈ íá åßíáé ðñïâëÝøéìåò, Þ ôïõëÜ÷éóôïí íá åëáôôù-
èåß ç åðßðôùóÞ ôïõò, êáé, ðáñÜëëçëá, äßíåé ôç äõíáôüôçôá Ýãêáéñçò êáé ïñèÞò áíôéìåôþðéóÞ ôïõò,
äéáôçñþíôáò õøçëü åðßðåäï õãéåéíÞò óôï ÷þñï ôïõ Íïóïêïìåßïõ.
ËÝîåéò êëåéäéÜ
Ëïéìþîåéò óôç ÌÅÈ, ôáîéíüìçóç ëïéìþîåùí, ìéêñïâéá-
êÞ öïñåßá.
ÅéóáãùãÞ
Ïé ëïéìþîåéò ðïõ åìöáíßæïíôáé óôï ðåñéâÜëëïí ôïõ íï-
óïêïìåßïõ áðïôåëïýí Ýíáí áðü ôïõò óðïõäáéüôåñïõò
ðáñÜãïíôåò ðïõ åðéäñïýí óôç äéÜñêåéá íïóçëåßáò
ôùí áóèåíþí, óôç èåñáðåõôéêÞ ôïõò áíôéìåôþðéóç êáé
ãåíéêÜ óôçí Ýêâáóç ôçò íüóïõ ôïõò. Ïé íïóïêïìåéá-
êÝò ëïéìþîåéò óõíéóôïýí Ýíá áðü ôá óçìáíôéêüôåñá
ðñïâëÞìáôá ðïõ áðáó÷ïëïýí ôçí õãåßá.1 ÅðçñåÜæïõí
äýï åêáôïììýñéá áóèåíåßò óôéò ÇÐÁ (5% ôùí íïóç-
ëåõüìåíùí áóèåíþí), ïäçãþíôáò óå 77.000 èáíÜôïõò
êáé óå äáðÜíåò 4,5 äéóåêáôïììõñßùí äïëáñßùí êÜèå
÷ñüíï.2
Éäéáßôåñá óôéò ìïíÜäåò åíôáôéêÞò èåñáðåßáò (ÌÅÈ),
ôï ðñüâëçìá áõôü åßíáé åíôïíüôåñï. Óå ãáëëéêÞ Ýñåõ-
íá ôï 1996, ðïõ áöïñïýóå ôï 58% ôùí êëéíþí óôá íï-
óïêïìåßá, âñÝèçêå Ýíá óõíïëéêü ðïóïóôü 6,7%
íïóïêïìåéáêþí ëïéìþîåùí, åíþ óôéò ÌÅÈ ôï ðïóïóôü
202
ôùí ëïéìþîåùí áõôþí áíôéóôïé÷ïýóå óôï 22%.3 Åðßóçò
áðü äéÜöïñåò Ýñåõíåò ôçò äéåèíïýò âéâëéïãñáößáò, ôá
ðïóïóôÜ ëïéìþîåùí ðïéêßëïõí áðü 13% Ýùò 42%.4-7 Ôï
áõîçìÝíï ðïóïóôü ôùí ëïéìþîåùí ðïõ åìöáíßæïíôáé
óôéò ÌÅÈ ó÷åôßæåôáé ìå ôéò éäéáßôåñåò óõíèÞêåò óôá
ôìÞìáôá áõôÜ ôïõ íïóïêïìåßïõ êáé ôçí ýðáñîç äéáöü-
ñùí ðáñáãüíôùí áõîçìÝíïõ êéíäýíïõ áíÜðôõîçò ëïé-
ìþîåùí.
Ìéá âáóéêÞ ðáñÜìåôñïò ôïõ åëÝã÷ïõ ôùí ëïéìþ-
îåùí ðïõ åìöáíßæïíôáé óôï ðåñéâÜëëïí ôïõ íïóïêï-
ìåßïõ, Üñá êáé óôï ÷þñï ôùí ÌÅÈ, åßíáé ç ôáîéíüìçóÞ
ôïõò óå êáôçãïñßåò ìå âÜóç ïñéóìÝíá êñéôÞñéá, äéá-
äéêáóßá ðïõ åßíáé åîáéñåôéêÜ óçìáíôéêÞ ãéá ôá ðñï-
ãñÜììáôá åëÝã÷ïõ ôùí íïóïêïìåéáêþí ëïéìþîåùí.8-9
Ç ôáîéíüìçóç ôùí ëïéìþîåùí ðïõ ÷ñçóéìïðïéåßôáé êõ-
ñßùò óôéò ìÝñåò ìáò åßíáé óýìöùíç ìå ôï Centre for
Disease Control (CDC),10-12 êáé óôçñßæåôáé, óõíÞèùò
ãéá ôá êïéíÜ âáêôÞñéá, óôï üñéï (cut off) ôùí 48 ùñþí
áðü ôç óôéãìÞ ôçò åéóáãùãÞò ôïõ áóèåíïýò óôï íï-
óïêïìåßï (http://medicalcollege.kku.edu.sa/pgcme/
Nosocomial/CDC%20Definitions.pdf).
Óýìöùíá, üìùò, ìå Ýñåõíåò, õðÜñ÷åé ç Üðïøç ãéá
ìéá Üëëç ðñüôáóç ôáîéíüìçóçò ôùí íïóïêïìåéáêþí
VOL. 54 • ISSUE 4, July - August 2009
Yðåýèõíïò áëëçëïãñáößáò
×ñÞóôïò Ôñéêáëéþôçò
Êýðñïõ 20, Åýïóìïò,
Ô.Ê. 56224, Èåóóáëïíßêç
ôçë. 2310-558333, 6972336264
e-mail: chris2504@hotmail.com
ëïéìþîåùí áóèåíþí ðïõ íïóçëåýïíôáé óôç ÌÅÈ. Ç
ôáîéíüìçóç áõôÞ äåí åîáñôÜôáé áðü ôï ÷ñüíï åìöÜ-
íéóçò ôçò ëïßìùîçò, áëëÜ áðü ôçí êáôÜóôáóç öïñåß-
áò ôùí áóèåíþí, üðùò áõôÞ ðñïóäéïñßæåôáé áðü ôçí
ðáñáêïëïýèçóç ôçò öïñåßáò öÜñõããá êáé ðåñéíÝïõ,
êáèþò êáé ôùí ëïéìþîåùí ðïõ ðáñïõóéÜæïíôáé óôïõò
áóèåíåßò áõôïýò.11
ÃåíéêÜ, åßíáé óçìáíôéêü íá ìðïñåß äéåõêñéíéóôåß ç
ðñïÝëåõóç ôùí äõíçôéêÜ ðáèïãüíùí ìéêñïïñãáíé-
óìþí ðïõ ìðïñåß íá ðñïêáëÝóïõí ëïéìþîåéò óôï ÷þ-
ñï ôùí ÌÅÈ, áí äçëáäÞ ïé ëïéìþîåéò ðñïÝñ÷ïíôáé
áðü ìéêñüâéá ôçò ÷ëùñßäáò ôùí ßäéùí ôùí áóèåíþí Þ
áí ó÷åôßæïíôáé ìå ôï ðåñéâÜëëïí ôçò ÌÅÈ (áóèåíåßò,
ðñïóùðéêü, Üøõ÷ï ðåñéâÜëëïí). ¸íá óçìáíôéêü ðï-
óïóôü ôùí ëïéìþîåùí ðñïêáëåßôáé áðü ìéêñüâéá ôçò
êïéíüôçôáò (åîùíïóïêïìåéáêÜ), ðïõ öÝñïõí ðñïç-
ãïõìÝíùò õãéÞ Üôïìá, ôá ïðïßá åéóÜãïíôáé ãéá íïóç-
ëåßá óôç ÌÅÈ. ÁíôéèÝôùò, ôá íïóïêïìåéáêÜ ìéêñüâéá
ðñïÝñ÷ïíôáé áðü áóèåíåßò ìå êÜðïéá õðïêåßìåíç íü-
óï ðïõ íïóçëåýïíôáé åðß ìáêñüí êáé óôïõò ïðïßïõò
÷ïñçãïýíôáé áíôéìéêñïâéáêÜ öÜñìáêá åõñÝùò öÜ-
óìáôïò, ïäçãþíôáò óõ÷íÜ óôçí áíÜðôõîç ðïëõáíèå-
êôéêþí ìéêñïïñãáíéóìþí.7,11,13 Ìéá Üëëç ðçãÞ
ìåôÜäïóçò ìéêñïïñãáíéóìþí êáé ìÜëéóôá áíèåêôéêþí
åßíáé ï éìáôéóìüò ôïõ ðñïóùðéêïý êáé ôï ðåñéâÜëëïí
ôçò ÌÅÈ. Áõôü éó÷ýåé éäéáßôåñá ãéá ôá õäñüöéëá
Gram-áñíçôéêÜ âáêôÞñéá, üðùò Pseudomonas spp,
Stenotrophomonas spp., Acinetobacter spp. êáé âáí-
êïìõêßíç áíèåêôéêïýò Enterococcus (VRE).14
Ãéá ôçí êáëýôåñç êáôáíüçóç ôçò ôáîéíüìçóçò áõ-
ôÞò ðáñáôßèåíôáé ïé ðáñáêÜôù ïñéóìïß:8,11
Öïñåßá ïñßæåôáé ç áðïìüíùóç ôïõ ßäéïõ ìéêñïïñ-
ãáíéóìïý (óå ïðïéáäÞðïôå óõãêÝíôñùóç) áðü ôïõëÜ-
÷éóôïí äýï äéáäï÷éêÜ äåßãìáôá ðáñáêïëïýèçóçò
(surveillance samples), óå ðåñßïäï ìßáò åâäïìÜäáò
ôï ëéãüôåñï.
Ìå âÜóç ôçí êáôÜóôáóç ôçò öïñåßáò, äéáêñßíïíôáé
ôñåéò ôýðïé ëïßìùîçò óôéò ÌÅÈ: á) ç ðñùôïãåíÞò åí-
äïãåíÞò ëïßìùîç, ðïõ ðñïêáëåßôáé áðü äõíçôéêÜ ðá-
èïãüíïõò ìéêñïïñãáíéóìïýò, ðïõ öÝñåé ï áóèåíÞò
êáé áíé÷íåýïíôáé óôï öÜñõããá Þ óôï ðåñßíåï êáôÜ ôçí
5-ereunitiki.qxd 14/10/2009 2:38 Page 203
ÌÅËÅÔÇ ÔÇÓ ÌÉÊÑÏÂÉÁÊÇÓ ÖÏÑÅÉÁÓ??????
ÔÙÍ ÁÓÈÅÍÙÍ
?????? ????????
åéóáãùãÞ ôïõ óôç ÌÅÈ, â) ç äåõôåñïãåíÞò åíäïãå-
íÞò ëïßìùîç, ðïõ ðñïêáëåßôáé áðü äõíçôéêÜ ðáèïãü-
íïõò ìéêñïïñãáíéóìïýò ðïõ áðïêôÜ ï áóèåíÞò êáôÜ
ôçí ðáñáìïíÞ ôïõ óôç ÌÅÈ êáé áíé÷íåýïíôáé óôï öÜ-
ñõããá Þ óôï ðåñßíåï êáé ã) ç åîùãåíÞò ëïßìùîç, ðïõ
ðñïêáëåßôáé áðü äõíçôéêÜ ðáèïãüíïõò ìéêñïïñãáíé-
óìïýò ðïõ ðñïÝñ÷ïíôáé áðü ôï ðåñéâÜëëïí ôçò ÌÅÈ,
Ýìøõ÷ï Þ Üøõ÷ï. Ôá âáêôÞñéá, óôçí ôåëåõôáßá ðåñß-
ðôùóç, ìåôáäßäïíôáé áð' åõèåßáò óôïí áóèåíÞ, ÷ùñßò
ðñïçãïýìåíç öïñåßá, ïðüôå ôá äåßãìáôá ðáñáêïëïý-
èçóçò öïñåßáò (öÜñõããá/ðåñéíÝïõ) åßíáé áñíçôéêÜ ãéá
ôïõò ìéêñïïñãáíéóìïýò ðïõ áíåõñÝèçêáí óôá êëéíé-
êÜ äåßãìáôá ôùí áóèåíþí, ôçí ßäéá ÷ñïíéêÞ ðåñßï-
äï.8,15
Ïé ðñùôïãåíåßò åíäïãåíåßò áöïñïýí åíäå÷ïìÝíùò
ìç íïóïêïìåéáêÝò ëïéìþîåéò, åíþ ìüíï ïé äåõôåñïãå-
íåßò åíäïãåíåßò êáé ïé åîùãåíåßò åßíáé ðñáãìáôéêÝò
ëïéìþîåéò ôçò ÌÅÈ. Ç ðáèïãÝíåóç üìùò áõôþí ôùí
äýï ôýðùí ëïßìùîçò ôçò ÌÅÈ åßíáé áñêåôÜ äéáöïñå-
ôéêÞ. Ïé äåõôåñïãåíåßò åíäïãåíåßò ëïéìþîåéò ðñïêá-
ëïýíôáé áðü äõíçôéêÜ ðáèïãüíïõò ìéêñïïñãáíéóìïýò
ðïõ õðÜñ÷ïõí óôï ðåñéâÜëëïí ôçò ÌÅÈ, áðïéêßæïõí
ôïõò áóèåíåßò êáé ðñïêáëïýí óå äåýôåñï ÷ñüíï ëïß-
ìùîç. Áíôßèåôá, ïé åîùãåíåßò ëïéìþîåéò ðñïêáëïýíôáé
áðü ó÷åôéæüìåíá ìå ôç ÌÅÈ âáêôÞñéá, ðïõ åéóÝñ÷ï-
íôáé áðåõèåßáò óôïí ïñãáíéóìü ôïõ îåíéóôÞ áðü ôï
ðåñéâÜëëïí. ÔõðéêÝò ôùí åîùãåíþí ëïéìþîåùí åßíáé
ïé ëïéìþîåéò ôùí êáôùôÝñùí áåñïöüñùí ïäþí áðü
Acinetobacter baumanii êáé Pseudomonas spp.
Ï ÷ñüíïò åìöÜíéóçò ôçò ëïßìùîçò äåí áðïôåëåß
áðïëýôùò áóöáëÞ ìÝèïäï ÷áñáêôçñéóìïý ôùí ëïé-
ìþîåùí ùò íïóïêïìåéáêÝò ëïéìþîåéò óôç ÌÅÈ, äéüôé
ï ÷ñüíïò åðþáóçò ôùí äéÜöïñùí ðáèïãüíùí ìéêñï-
ïñãáíéóìþí äåí åßíáé äõíáôü íá êáèïñéóèåß ìå áêñß-
âåéá. Ç êáôçãïñéïðïßçóç, ëïéðüí, ôùí ëïéìþîåùí ìå
âÜóç ôçí ðáñáðÜíù ðñïôåéíüìåíç ôáîéíüìçóç ìðï-
ñåß íá ðñïóöÝñåé Ýíá éäéáßôåñá ÷ñÞóéìï åñãáëåßï
óôçí êáëýôåñç êáôáíüçóç ôïõ ìç÷áíéóìïý áíÜðôõ-
îçò ôùí ëïéìþîåùí êáé öõóéêÜ óôçí áðïôåëåóìáôéêü-
ôåñç áíôéìåôþðéóÞ ôïõò.11
Óêïðüò ôçò ðáñïýóáò åñãáóßáò Þôáí ç åðéäçìéï-
ëïãéêÞ ìåëÝôç ôçò öïñåßáò ôùí áóèåíþí ôçò ÌÅÈ
êáé ç äéåñåýíçóç ôçò ó÷Ýóçò ôçò ìå ëïéìþîåéò ðïõ
áíáðôý÷èçêáí êáôÜ ôç äéÜñêåéá ôçò íïóçëåßáò ôïõò
óå áõôÞ. Åéäéêüôåñá, ìå ôçí åðéäçìéïëïãéêÞ ìåëÝôç
ôçò öïñåßáò êáé ôùí ëïéìþîåùí ôùí áóèåíþí ôçò
ÌÅÈ Ýãéíå ðñïóðÜèåéá 1) äéÜêñéóçò ôùí "åéóáãüìå-
íùí" ìéêñïïñãáíéóìþí áðü áõôïýò ðïõ áðïêôÞèç-
êáí óôç ÌÅÈ, óýìöùíá ìå ôçí ôáîéíüìçóç ôùí
ëïéìþîåùí ðïõ ðñïôåßíåôáé ðáñáðÜíù, 2) ìåßùóçò
ôïõ áñéèìïý ôùí ðñáãìáôéêþí ëïéìþîåùí ôçò ÌÅÈ
êáé 3) áðïöõãÞò ìç áðáñáßôçôùí êáé Üóêïðùí äéáäé-
êáóéþí ãéá ôç äéÜãíùóç ôçò ëïßìùîçò, êáé üëá áõôÜ
ìå áðþôåñï óôü÷ï ìéá ðéï ñåáëéóôéêÞ åéêüíá ôçò åðé-
äçìéïëïãßáò ôùí ëïéìþîåùí ðïõ åìöáíßæïíôáé óôç
ÌÅÈ.
ÌÅÈ ÊÁÉ Ç????
ÓÕÌÂÏËÇ ÔÇÓ????????????
??????? ÓÔÇÍ ÁÍÔÉÌÅÔÙÐÉÓÇ ÔÙÍ ËÏÉÌÙÎÅÙÍ
??? Blastocystis sp.
Õëéêü êáé ìÝèïäïò
Ôï õëéêü ðïõ ÷ñçóéìïðïéÞèçêå ðñïÞëèå áðü áóèå-
íåßò ôçò Á´ ÌÅÈ ôïõ Ãåíéêïý Íïóïêïìåßïõ "Ã. Ðáðá-
íéêïëÜïõ" ðïõ íïóçëåýôçêáí ôï äéÜóôçìá 2005-2007.
ÓõãêåêñéìÝíá ðñüêåéôáé ãéá áóèåíåßò ðïõ åéóÞ÷èçóáí
áð' åõèåßáò óôç ÌÅÈ, äçëáäÞ äåí ðñïÝñ÷ïíôáí áðü
Üëëç êëéíéêÞ ôïõ íïóïêïìåßïõ Þ áðü êÜðïéï Üëëï íï-
óçëåõôéêü ßäñõìá êáé õðÞñ÷áí ïé ðñïûðïèÝóåéò ãéá
ôçí åîáóöÜëéóç ôùí áðáñáßôçôùí äåéãìÜôùí (ðáñá-
ìïíÞ 10-12 çìÝñåò óôç ÌïíÜäá).
Óôïõò õðü ìåëÝôç áóèåíåßò Ýãéíå ëÞøç åðé÷ñéóìÜ-
ôùí áðü ôï öÜñõããá êáé ôï ðåñßíåï óå åéäéêÜ õëéêÜ
ìåôáöïñÜò Stuart (NUOVA APTACA, Italy) êáôÜ ôçí
åéóáãùãÞ ôïõò óôç ÌÅÈ êáé ìåôÜ áíÜ 3Þìåñï êáôÜ ôç
äéÜñêåéá ôçò íïóçëåßáò ôïõò, äçëáäÞ óõíïëéêÜ ëÞøç
3-4 äåéãìÜôùí áðü öÜñõããá/ðåñßíåï. Óôç óõíÝ÷åéá
áêïëïýèçóå êáëëéÝñãåéá ôùí äåéãìÜôùí áõôþí ìå åì-
âïëéáóìü ôïõò óå óôåñåÜ èñåðôéêÜ õëéêÜ (áéìáôïý÷ï
Üãáñ ìå 5% áßìá ðñïâÜôïõ, MacConkey, Chapman
êáé Sabouraud Üãáñ). Ôá ôñõâëßá åðùÜóôçêáí áåñï-
âßùò óå êëßâáíï 37ïC ãéá 24 þñåò.
ÐáñÜëëçëá, óå õðïøßá ëïßìùîçò, ãßíïíôáí äéáãíù-
óôéêÝò êáëëéÝñãåéåò êëéíéêþí äåéãìÜôùí ôùí áóèåíþí
(áßìá, ïýñá, ðôýåëá, âñïã÷éêÝò åêêñßóåéò, âñïã÷ïêõ-
øåëéäéêÜ åêðëýìáôá, ðýïí). Ï åìâïëéáóìüò êáé ç åðþ-
áóç ôùí ðáñáðÜíù âéïëïãéêþí õëéêþí Ýãéíå óýìöùíá
ìå ôéò óõíÞèåéò ìåèüäïõò ôïõ åñãáóôçñßïõ. Ç ôáõôï-
ðïßçóç ôùí ìéêñïâßùí ðïõ áðïìïíþèçêáí Ýãéíå ìå ôï
áõôïìáôïðïéçìÝíï óýóôçìá VITEK 2 (bioMerieux S.A.,
Marcy l' Etoile, France).
ÁðïôåëÝóìáôá
203
ÓõíïëéêÜ ìåëåôÞèçêáí 96 áóèåíåßò. Áðü áõôïýò ðïë-
ëïß áóèåíåßò äåí åìöÜíéóáí ëïßìùîç, Üëëïé êáôÝëç-
îáí ëüãù ôçò óïâáñüôçôáò ôçò íüóïõ ôïõò, ãéá ôçí
ïðïßá íïóçëåýôçêáí óôç ÌÅÈ, êáé Üëëïé äéåêïìßóèç-
êáí óýíôïìá óå Üëëç êëéíéêÞ ëüãù âåëôßùóçò ôçò êá-
ôÜóôáóÞò ôïõò. ÔñéÜíôá Ýíáò áðü ôïõò áóèåíåßò
áíÝðôõîáí óõíïëéêÜ 78 ëïéìþîåéò, äçëáäÞ óå áñêå-
ôïýò ðáñïõóéÜóôçêáí ðåñéóóüôåñåò áðü ìßá ëïéìþ-
îåéò (ðïëëáðëÝò ëïéìþîåéò). Áðü áõôÝò 26
êáôáôÜóóïíôáé, óýìöùíá ìå ôçí ôáîéíüìçóç ðïõ
ðñïôåßíåôáé, óôéò ðñùôïãåíåßò åíäïãåíåßò (26/78,
33,3%), äçëáäÞ ç ëïßìùîç ïöåéëüôáí óôïí ßäéï ìéêñï-
ïñãáíéóìü ðïõ áíåõñÝèçêå êáé óôï åðß÷ñéóìá ôïõ
öÜñõããá Þ ðåñéíÝïõ ôïõ áóèåíïýò êáôÜ ôçí åßóïäü
ôïõ óôç ÌÅÈ. Ïé 34 ëïéìþîåéò Þôáí äåõôåñïãåíåßò åí-
äïãåíåßò (34/78, 43,6%), äçëáäÞ ðñïÞëèáí áðü ìé-
êñüâéá ðïõ áðïßêéóáí ôïí áóèåíÞ êáôÜ ôçí ðáñáìïíÞ
ôïõ óôç ÌÅÈ êáé åìöáíßóôçêáí áñãüôåñá ùò öïñåßá
öÜñõããá Þ ðåñéíÝïõ ôïõ áóèåíïýò. ÔÝëïò, ïé 18 ëïé-
ìþîåéò Þôáí åîùãåíåßò (18/78, 23,1%), äçëáäÞ ïöåß-
ëïíôáí óå äõíçôéêÜ ðáèïãüíïõò ìéêñïïñãáíéóìïýò
áðü ôï ðåñéâÜëëïí ôçò ÌÅÈ (Ýìøõ÷ï êáé Üøõ÷ï), ïé
ïðïßïé ðñïêÜëåóáí ôç ëïßìùîç ÷ùñßò íá ìåôáâÜëïõí
ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009
5-ereunitiki.qxd 14/10/2009 2:38 Page 204
×. ÔÑÉÊÁËÉÙÔÇÓ, Â. ÓÏÕËÏÕÍÔÆÇ, Å. ÊÁÔÓÉÖÁ ÊÁÉ ÓÕÍ.
ÊáôáíïìÞ ôùí ëïéìþîåùí óôç ÌÅÈ óýìöùíá ìå ôï
Ðßíáêáò 1 êñéôÞñéï ôçò öïñåßáò.
Åßäïò ÐñïÝëåõóç
ëïéìþîåùí Áñéèìüò Ðïóïóôü ðïóïóôü (%)
Ðñùôïãåíåßò 26 33,3% ÅîùíïóïêïìåéáêÝò
-åíäïãåíåßò (33,3%)
Äåõôåñïãåíåßò 34 43,6%
-åíäïãåíåßò ÍïóïêïìåéáêÝò
Åîùãåíåßò 18 23,1% (66,7%)
ôç öïñåßá ôïõ áóèåíïýò, ïðüôå êáé ïé êáëëéÝñãåéåò
áðü ôï åðß÷ñéóìá ôïõ öÜñõããá/ðåñéíÝïõ ôùí áóèå-
íþí Þôáí áñíçôéêÝò ãéá ôá óõãêåêñéìÝíá ìéêñüâéá. Ìå
âÜóç ôçí áêïëïõèïýìåíç ôáîéíüìçóç, 66,7% ôùí ëïé-
ìþîåùí (óýíïëï äåõôåñïãåíþí åíäïãåíþí êáé åîù-
ãåíþí) ÷áñáêôçñßæïíôáé íïóïêïìåéáêÝò (ëïéìþîåéò
óôç ÌÅÈ), åíþ 33,3% ÷áñáêôçñßæïíôáé ùò ðñùôïãå-
íåßò åíäïãåíåßò êáé áöïñïýí, åíäå÷ïìÝíùò, åîùíï-
óïêïìåéáêÝò ëïéìþîåéò (Ðßíáêáò 1).
ÁíÜëïãá ìå ôçí åíôüðéóç ôçò ëïßìùîçò óçìåéþèç-
êáí: 41 ðåñéóôáôéêÜ óçøáéìßáò (41/78, 52,6%), 18 ëïé-
ìþîåéò áíáðíåõóôéêïý óõóôÞìáôïò (18/78, 23,1%), 5
ïõñïëïéìþîåéò (5/78, 6,4%), 7 ëïéìþîåéò êåíôñéêïý
íåõñéêïý óõóôÞìáôïò (5/78, 9%) êáé 7 äéÜöïñåò Üë-
ëåò ëïéìþîåéò (7/78, 9%) (Åéêüíá 1). Ï áñéèìüò êáé ôï
åßäïò ôùí ìéêñïïñãáíéóìþí ðïõ áðïìïíþèçêáí áðü
ôéò ëïéìþîåéò ðïõ áíáðôý÷èçêáí óôïõò áóèåíåßò ôùí
ÌÅÈ, óå ó÷Ýóç ìå ôïí ôýðï ôçò ëïßìùîçò ðïõ åìöá-
íßóôçêå, ðáñïõóéÜæïíôáé óõíïðôéêÜ óôçí åéêüíá 2.
Ïé ðñùôïãåíåßò åíäïãåíåßò ëïéìþîåéò ðñïêëÞèç-
êáí êõñßùò áðü ôïí S. epidermidis êáé Üëëïõò ðçêôÜ-
204 óç áñíçôéêïýò óôáöõëüêïêêïõò (Coagulase Negative
Staphylococcus, CNS) (14/26, 53,8%), åíþ A. bauma-
nii åõèýíåôáé ãéá ôéò ðåñéóóüôåñåò äåõôåñïãåíåßò åí-
äïãåíåßò (13/34, ðïóïóôü 38,2%) êáé åîùãåíåßò
ëïéìþîåéò (8/18, ðïóïóôü 44,4%), ãåãïíüò ðïõ ôïíß-
æåé ôï ðñüâëçìá ôïõ áðïéêéóìïý ôùí áóèåíþí ìÝóá
óôéò ÌïíÜäåò, áöïý åßíáé ãíùóôü ðùò ôï óõãêåêñéìÝ-
VOL. 54 • ISSUE 4, July - August 2009
íï ìéêñüâéï åíäçìåß óôï ðåñéâÜëëïí ôçò ÌÅÈ. Óôïí
ðßíáêá 2 ðáñïõóéÜæåôáé ï áñéèìüò ôùí ìéêñïïñãáíé-
óìþí ðïõ áðïìïíþèçêáí óå ó÷Ýóç ìå ôï åßäïò ôçò
ëïßìùîçò (óçøáéìßá, ëïßìùîç áíáðíåõóôéêïý, ïõñï-
ëïßìùîç êôë.) ðïõ åìöÜíéóáí ïé áóèåíåßò.
ÓõæÞôçóç
Ç ãíþóç ôçò öïñåßáò ôùí áóèåíþí ðïõ íïóçëåýï-
íôáé åðß ìáêñüí óôç ÌÅÈ ìðïñåß íá ðñïóöÝñåé ìéá
ðéï ñåáëéóôéêÞ åéêüíá ôçò åðéäçìéïëïãßáò ôùí ëïéìþ-
îåùí ðïõ ðáñáôçñïýíôáé óå áõôÞ.8,11 Áõôü åðéôõã÷Ü-
íåôáé ìå ôç äéáäï÷éêÞ ëÞøç 3-4 äåéãìÜôùí áðü ôï
öÜñõããá êáé ôï ðåñßíåï ôïõ áóèåíïýò, áðü ôç óôéã-
ìÞ ôçò åéóáãùãÞò ôïõ êáé áíÜ 3Þìåñï, êáé ôçí ðåñáé-
ôÝñù áîéïëüãçóÞ ôïõò áðü ôï ìéêñïâéïëïãéêü
åñãáóôÞñéï. Áðü ôçí Üëëç ðëåõñÜ, ç áðïìüíùóç êáé
ôáõôïðïßçóç ôùí ìéêñïïñãáíéóìþí ðïõ ðñïêÜëåóáí
ëïßìùîç (Þ ëïéìþîåéò) óôïõò íïóçëåõüìåíïõò óôç
ÌÅÈ, êáé ç óýãêñéóç ôùí áðïôåëåóìÜôùí ìå ôç öï-
ñåßá ôùí áóèåíþí, åðéôñÝðåé ôçí êáôçãïñéïðïßçóç
ôùí ëïéìþîåùí, óýìöùíá ìå ôçí ðñïôåéíüìåíç ôáîé-
íüìçóç, óå ðñùôïãåíåßò åíäïãåíåßò, äåõôåñïãåíåßò
åíäïãåíåßò êáé åîùãåíåßò ëïéìþîåéò.
¸÷åé Þäç áíáöåñèåß óôçí åéóáãùãÞ, üôé ïé "ðñáã-
ìáôéêÝò" íïóïêïìåéáêÝò ëïéìþîåéò ðïõ åìöáíßæïíôáé
óôç ÌÅÈ, äçëáäÞ áõôÝò ðïõ ðñïêáëïýíôáé áðü ìé-
êñüâéá ðïõ ðñïÝñ÷ïíôáé áðü ôï ðåñéâÜëëïí ôçò
ÌÅÈ, áöïñïýí ôéò äåõôåñïãåíåßò åíäïãåíåßò êáé åîù-
ãåíåßò ëïéìþîåéò, åíþ ïé ðñùôïãåíåßò åíäïãåíåßò áíôé-
ðñïóùðåýïõí ëïéìþîåéò ôçò êïéíüôçôáò (ðéèáíüí
åîùíïóïêïìåéáêÝò). Ïé ôåëåõôáßåò ïöåßëïíôáé óå ìé-
êñïïñãáíéóìïýò ðïõ öÝñåé ï áóèåíÞò áðü ôçí êïé-
íüôçôá, äåí Ý÷ïõí êáìßá ó÷Ýóç ìå ôá ìéêñüâéá ðïõ
åíäçìïýí óôç ÌÅÈ êáé åðïìÝíùò äåí åßíáé ðñïâëÝøé-
ìåò. Áíôßèåôá, ïé äåõôåñïãåíåßò åíäïãåíåßò êáé åîùãå-
íåßò ëïéìþîåéò ìðïñïýí íá ðñïâëåöèïýí ìÝóù ôçò
ãíþóçò ôçò öïñåßáò ôùí áóèåíþí êáôÜ ôçí åéóáãù-
ãÞ ôïõò óôç ÌÅÈ êáé ôõ÷üí ìåôáâïëÞ áõôÞò êáôÜ ôç
äéÜñêåéá ôçò ðáñáìïíÞò ôïõò óå áõôÞ.
Åéêüíá 1. Åßäç ëïéìþîåùí áíÜëïãá
ôçò åíôüðéóçò.
5-ereunitiki.qxd 14/10/2009 2:38 Page 205

ÌÅËÅÔÇ ÔÇÓ ÌÉÊÑÏÂÉÁÊÇÓ ÖÏÑÅÉÁÓ??????

ÔÙÍ ÁÓÈÅÍÙÍ ÌÅÈ ÊÁÉ Ç????
?????? ???????? ÓÕÌÂÏËÇ ÔÇÓ????????????
??????? ÓÔÇÍ ÁÍÔÉÌÅÔÙÐÉÓÇ ÔÙÍ ËÏÉÌÙÎÅÙÍ
??? Blastocystis sp.

Åéêüíá 2. ÊáôáíïìÞ ôùí ìéêñïïñãáíé-

óìþí áíÜëïãá ìå ôïí ôýðï
ôçò ëïßìùîçò.

Óýìöùíá ìå ôï üñéï ôùí 48 ùñþí ðïõ ðñïôåßíåé
ôï CDC, ìéá ëïßìùîç èåùñåßôáé åîùíïóïêïìåéáêÞ áí
áíáðôõ÷èåß óå ÷ñüíï ≤48 þñåò áðü ôçí åéóáãùãÞ ôïõ
áóèåíïýò, êáé íïóïêïìåéáêÞ áí áíáðôõ÷èåß óå ÷ñüíï
>48 þñåò. Áõôüò, üìùò ï ôñüðïò êáèïñéóìïý ôùí
ëïéìþîåùí, áí êáé ÷ñÞóéìïò óôç äéá÷åßñéóç êáé áíôé-
ìåôþðéóç ôùí ëïéìþîåùí, ðñáêôéêÜ äçìéïõñãåß êÜðïéá
ðñïâëÞìáôá.12,16,17 ¸ôóé, ìéá ëïßìùîç ðïõ åìöáíßæå-
ôáé óôç ìïíÜäá êáé ðïõ ïöåßëåôáé óå Ýíá ìéêñïïñãá-
íéóìü ôïí ïðïßï öÝñåé ï áóèåíÞò êáôÜ ôçí åßóïäü ôïõ
óôç ÌÅÈ äåí ìðïñåß íá èåùñçèåß êáô' áíÜãêç íïóï-
êïìåéáêÞ ëïßìùîç, Ýóôù êáé áí áíáðôýóóåôáé ðÝñáí
ôùí 48 ùñþí, áöïý ï õðåýèõíïò ìéêñïïñãáíéóìüò
äåí Ý÷åé ó÷Ýóç ìå ôçí ïéêïëïãßá ôçò ÌÅÈ. ¸ôóé, åÜí
óôçí ðáñïýóá åñãáóßá êáôáãñÜöïíôáí ôá ðïóïóôÜ
ôùí íïóïêïìåéáêþí - åîùíïóïêïìåéáêþí ëïéìþîåùí
ìå âÜóç ôï CDC, èá õðÞñ÷áí 11 ðåñéóóüôåñåò íïóï-
êïìåéáêÝò ëïéìþîåéò (ðïóïóôü 14,1%), óå ó÷Ýóç ìå
åêåßíåò ôïõ êñéôçñßïõ ôçò öïñåßáò ôùí áóèåíþí (Ðßíá-
êáò 3). Ìå âÜóç ôï êñéôÞñéï áõôü, ïé éáôñïß ôçò ÌÅÈ
åßíáé óå èÝóç íá ãíùñßæïõí åê ôùí ðñïôÝñùí, ôïõëÜ-
205
÷éóôïí 24-48 þñåò íùñßôåñá, ôá ðéèáíÜ ëïéìïãüíá

ÊáôáíïìÞ ôùí ìéêñïïñãáíéóìþí óå ó÷Ýóç ìå ôçí åíôüðéóç ôçò ëïßìùîçò.

Ðßíáêáò 2

Ëïßìùîç Ëïßìùîç
Óçøáéìßá áíáðíåõóôéêïý Ïõñïëïßìùîç ÊÍÓ ¢ëëåò Óýíïëï
Acinetobacter baumanii 4 11 1 3 4 23
Coagulase negative staphylococci 19 1 – 1 – 21
Enterococcus faecalis 5 – 1 1 – 7
Enterococcus faecium 2 – – 1 – 3
Pseudomonas aeruginosa 3 2 1 – 2 8
Staphylococcus aureus 2 3 – – – 5
Enterobacter cloacae 2 – – – 1 3
Enterobacter aerogenes 1 – 1 – – 2
Klebsiella oxytoca 2 – – – – 2
Escherichia coli – – 1 – – 1
Pseudomonas putida 1 – – – – 1
Streptococcus spp – – – 1 – 1
Candida intermedia – 1 – - – 1
Óýíïëï 41 18 5 7 7 78

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5-ereunitiki.qxd 14/10/2009 2:38 Page 206
×. ÔÑÉÊÁËÉÙÔÇÓ, Â. ÓÏÕËÏÕÍÔÆÇ, Å. ÊÁÔÓÉÖÁ ÊÁÉ ÓÕÍ.
Óýãêñéóç ôùí êñéôÞñéùí öïñåßáò êáé ïñßïõ 48 ùñþí
Ðßíáêáò 3 ãéá ôçí ôáîéíüìçóçò ôùí ëïéìþîåùí óôç ÌÅÈ.
ÊñéôÞñéï öïñåßá ÊñéôÞñéï CDC
(48 þñåò)
Áñéèìüò Ðïóïóôü Áñéèìüò Ðïóïóôü
ÅîùíïóïêïìåéáêÝò 26* 33,3% 15 19,2%
ÍïóïêïìåéáêÝò 52** 66,7% 63 80,8%
Óýíïëï 78 78
* ÅîùíïóïêïìåéáêÝò = ðñùôïãåíåßò åíäïãåíåßò
** ÍïóïêïìåéáêÝò = äåõôåñïãåíåßò åíäïãåíåßò (34) êáé åîùãå-
íåßò (18)
óôåëÝ÷ç ãéá êÜèå áóèåíÞ, ðïõ áðïêôÞèçêáí óôç ÌÅÈ.
¸ôóé, ìðïñåß íá åðéôåõ÷èåß ìéá ðéï Ýãêáéñç êáé áðïôå-
ëåóìáôéêÞ áíôéìåôþðéóç ôçò ëïßìùîçò ðïõ ðéèáíÜ èá
åìöáíßóåé ï áóèåíÞò, áöïý ìðïñåß íá ãßíåé ïñèüôåñç
åðéëïãÞ ôùí áíôéìéêñïâéáêþí ðáñáãüíôùí. ÐáñÜëëç-
ëá, åßíáé ðéèáíü, ìå ôïí ôñüðï áõôü, íá åðéôåõ÷èåß
Ýëåã÷ïò êáé ìåßùóç ôùí ðïëõáíèåêôéêþí óôåëå÷þí,
ðïõ áöèïíïýí óôï ðåñéâÜëëïí ôçò ÌÅÈ ëüãù ôùí
éäéáßôåñùí óõíèçêþí ðïõ åðéêñáôïýí,13 êáèþò êáé ïñ-
èïëïãéêüôåñç ÷ñÞóç ôùí áíôéâéïôéêþí.
Êõñßùò üìùò ìå ôçí ðñïôåéíüìåíç ôáîéíüìçóç
äéá÷ùñßæïíôáé ïé ðñïâëÝøéìåò áðü ôéò ìç ðñïâëÝøé-
ìåò ëïéìþîåéò. Ç äéåèíÞò åìðåéñßá Ý÷åé äåßîåé üôé ôá
åðéäçìéïëïãéêÜ äåäïìÝíá ìðïñïýí íá ïäçãÞóïõí óå
áðïôåëåóìáôéêÞ áíÜðôõîç ðñïãñáììÜôùí åëÝã÷ïõ
ôùí ëïéìþîåùí êáé óå ìåßùóç áõôþí ðïõ åßíáé ðñï-
âëÝøéìåò (äåõôåñïãåíåßò åíäïãåíåßò êáé åîùãåíåßò
ëïéìþîåéò).10 Ôá ìéêñïâéáêÜ óôåëÝ÷ç ðïõ ôéò ðñïêá-
ëïýí, üðùò ð.÷. ëïßìùîç êáôùôÝñùí áåñïöüñùí
206
ïäþí áðü A. baumanii ëüãù ÷ñÞóçò ìïëõóìÝíïõ åîï-
ðëéóìïý ìç÷áíéêïý áåñéóìïý,8,18 åßíáé Üññçêôá óõí-
äåäåìÝíá ìå ôéò "ðñáãìáôéêÝò" íïóïêïìåéáêÝò
ëïéìþîåéò. Ç áíôéìåôþðéóÞ ôïõò åßíáé åöéêôÞ ìå ôç äé-
áôÞñçóç õøçëïý åðéðÝäïõ õãéåéíÞò ìÝóá óôç ÌÅÈ
êáé ôï íïóïêïìåßï. Ï ðëÝïí áðëüò êáé áðïôåëåóìáôé-
êüò ôñüðïò åßíáé ôï ðëýóéìï ôùí ÷åñéþí. ÄéÜöïñåò
ìåëÝôåò áðü ÌÅÈ áðü ôéò ÇÐÁ20, äåß÷íïõí üôé ôï éá-
ôñïíïóçëåõôéêü ðñïóùðéêü äåí åöáñìüæåé ó÷ïëáóôé-
êÜ ôçí õãéåéíÞ ôùí ÷åñéþí ðñéí êáé ìåôÜ ôçí åðáöÞ
ôïõ ìå ôïí áóèåíÞ, ìå áðïôÝëåóìá ôçí áýîçóç ôïõ
ðïóïóôïý ôùí íïóïêïìåéáêþí ëïéìþîåùí.11,19,20,21
Åêôüò âÝâáéá áðü ôçí áðëÞ áõôÞ ïäçãßá ãéá ôç óùóôÞ
õãéåéíÞ ôùí ÷åñéþí, ï Ýëåã÷ïò ôùí ëïéìþîåùí èá ðñÝ-
ðåé íá óõìðåñéëáìâÜíåé ðñïãñÜììáôá åëÝã÷ïõ, Ýñåõ-
VOL. 54 • ISSUE 4, July - August 2009
íáò êáé êáôáãñáöÞò ôùí ëïéìþîåùí, äéáëÝîåéò êáé
ãñáðôÝò ïäçãßåò ãéá ôç óõíå÷Þ åðéìüñöùóç ôùí åñ-
ãáæïìÝíùí óôï ÷þñï ôçò õãåßáò óýìöùíá êáé ìå ôéò
ïäçãßåò ðïõ ðñïÝêõøáí áðü ôçí ìåëÝôç áðïôåëåóìá-
ôéêüôçôáò ôïõ ðñïãñÜììáôïò åëÝã÷ïõ íïóïêïìåéá-
êþí ëïéìþîåùí óôéò ÇÐÁ (Study on the Efficacy of
Nosocomial Infection Control Project, SENIC).22
Ïé íïóïêïìåéáêÝò ëïéìþîåéò åßíáé Ýíá óçìáíôéêü êå-
öÜëáéï óôç ëåéôïõñãßá åíüò íïóïêïìåßïõ êáé ç åðßðôù-
óÞ ôïõò áðïôåëåß äåßêôç ôçò ðïéüôçôáò ôçò
ðáñå÷üìåíçò ðåñßèáëøçò.23 Åßíáé åðïìÝíùò áðáñáß-
ôçôïò ãéá ôéò êëéíéêÝò, êáé êõñßùò ãéá ôéò ÌÅÈ, ï Ýëåã-
÷ïò êáé ç ðáñáêïëïýèçóç áíÜðôõîçò íïóïêïìåéáêþí
ëïéìþîåùí, þóôå íá êáèïñéóôïýí åíäçìéêïß äåßêôåò, íá
áíé÷íåõèïýí åðéäçìßåò êáé íá åöáñìïóôïýí áðïôåëå-
óìáôéêÜ ìÝôñá åëÝã÷ïõ.24,25 Ï ñüëïò ôïõ ìéêñïâéïëï-
ãéêïý åñãáóôçñßïõ åßíáé êáèïñéóôéêüò óôá óõóôÞìáôá
ðáñáêïëïýèçóçò êáé êáôáãñáöÞò ôùí íïóïêïìåéáêþí
ëïéìþîåùí 26-32, åðéôñÝðïíôáò ôç óõëëïãÞ äåäïìÝ-
íùí áðü ôï ÷þñï ôïõ íïóïêïìåßïõ êáé ôçí åðåîåñãá-
óßá ôïõò ãéá åðéäçìéïëïãéêïýò óêïðïýò.33
ÓõìðåñáóìáôéêÜ, ç ðñïôåéíüìåíç êáôçãïñéïðïßç-
óç ôùí ëïéìþîåùí, ìå âÜóç ôçí êáôÜóôáóç öïñåßáò
ôïõ áóèåíïýò êáé ç ðáñáêïëïýèçóç ôçò ìåôáâïëÞò
ôçò ìå ôéò êáëëéÝñãåéåò åðéôÞñçóçò, ìðïñåß íá ðñï-
óöÝñåé óçìáíôéêÞ âïÞèåéá óå ó÷Ýóç ìå ôç äéÜêñéóç
ôùí ëïéìþîåùí ìå âÜóç ôï ÷ñïíéêü üñéï ôùí 48 ùñþí
ôïõ CDC. ÌÝóá áðü ôçí êáëýôåñç êáôáíüçóç ôçò åðé-
äçìéïëïãßáò ôùí ëïéìþîåùí ðïõ óõìâáßíïõí óôï ÷þ-
ñï ôçò ÌÅÈ, ç ðáñáðÜíù ôáîéíüìçóç äßíåé ôç
äõíáôüôçôá íá ÷áñáêôçñéóôïýí ïé åíäå÷üìåíåò ëïé-
ìþîåéò ðñïâëÝøéìåò êáé ôïõëÜ÷éóôïí íá åëáôôùèåß ç
åðßðôùóÞ ôïõò ìå ôç äéáôÞñçóç õøçëïý åðéðÝäïõ
õãéåéíÞò. Óôçí ðáñïýóá åñãáóßá Ýãéíå ðñïóðÜèåéá
äéá÷ùñéóìïý åîùíïóïêïìåéáêþí êáé íïóïêïìåéáêþí
óôåëå÷þí ìéêñïâßùí óôç ÌÅÈ, ãåãïíüò ðïõ èá ìðï-
ñïýóå íá óõìâÜëëåé óôçí ðñüëçøç, óôçí Ýãêáéñç êáé
áðïôåëåóìáôéêüôåñç èåñáðåßá ôùí áóèåíþí, óôçí
åëÜôôùóç ôïõ ÷ñüíïõ íïóçëåßáò ôïõò, óôç ìåßùóç
ôùí äáðáíþí íïóçëåßáò, êáèþò êáé óôç ìåßùóç ôçò
åðßðôùóçò åìöÜíéóçò ðïëõáíèåêôéêþí ìéêñïâéáêþí
óôåëå÷þí. Ç êáôáãñáöÞ, ôÝëïò, ôçò ÷ëùñßäáò ôùí
áóèåíþí, êáôÜ ôçí åéóáãùãÞ ôïõò (screening) êáé ôç
äéÜñêåéá ôçò íïóçëåßáò ôïõò óôç ÌÅÈ, ìðïñåß íá âï-
çèÞóåé óôçí êáëýôåñç ðáñáêïëïýèçóç êáé èåñáðåßá
ôùí ðéèáíþí ëïéìþîåùí óôïõò áóèåíåßò áõôïýò, êá-
èþò êáé óôç ìåßùóç ôçò íïóçñüôçôáò êáé èíçôüôçôáò
áðü áõôÝò.34
5-ereunitiki.qxd 14/10/2009 2:38 Page 207

ÌÅËÅÔÇ ÔÇÓ ÌÉÊÑÏÂÉÁÊÇÓ ÖÏÑÅÉÁÓ??????

ÔÙÍ ÁÓÈÅÍÙÍ ÌÅÈ ÊÁÉ Ç????
?????? ???????? ÓÕÌÂÏËÇ ÔÇÓ????????????
??????? ÓÔÇÍ ÁÍÔÉÌÅÔÙÐÉÓÇ ÔÙÍ ËÏÉÌÙÎÅÙÍ
??? Blastocystis sp.

Summary

Microbiological carrier status of intensive care unit patients and

contribution to infection management

C. Trikaliotis1, V. Soulountzi2, E. Katsifa1, E. Tsorlini1, M. Bitziani2, M. Vagiona3

1Microbiology Department, Genenal Hospital “G. Papanikolaou”, Thessaloniki, Greece
2A´Intensive Care Unit, Genenal Hospital “G. Papanikolaou”, Thessaloniki Greece
3Hygiene Laboratory, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

The aim of this study was the better comprehension of the epidemiology of infections which occur
in the intensive care unit (ICU) using a new classification that has been proposed. This classifica-
tion distinguishes the infections in primary endogenous, secondary endogenous and exogenous,
and is based on the study of the carrier status of patients during their stay in the ICU. The material
used in this survey was derived from patients who were hospitalized into the First ICU of General
Hospital "G. Papanikolaou", during the period 2005-2007 and who were not transferred from an-
other clinic of the same hospital or another hospital. Culture swabs were taken from the pharynx and
perineum of the studied patients during their ICU admission and from then onwards every 3 days
throughout their hospitalization. At the same time, on suspicion of infection, diagnostic cultures of
clinical samples (blood, urine, sputum, bronchial excretion, lavage, pus) from the selected patients
were made. A total of 96 patients hospitalized in ICU were studied. In 31 of them, a total of 78 infe-
ctions were developed. According to the proposed classification, 28 of the infections were primary
endogenous (33.3%), 34 secondary endogenous (rate 43.6%) and 18 exogenous (23.1%). Accor-
ding to the 48 hour - criterion of the Centre of Disease Control, hospital-acquired (nosocomial) in-
fections were estimated to be 63 (rate 80.8%), while the community-acquired 15 (rate 19.2%).
However, using the criterion of the carrier status, there were 11 fewer infections characterized as no-
socomial (14.1%). The most frequent microorganisms were Acinetobacter baumanii (29.5%) and
207
Coagulase Negative Staphylococci (26.9%). In conclusion, based on the classification of infections
according to the carrier status of the patients, we were capable of knowing in advance the source
of microorganisms that cause the infection. This classification can help to predict potential infe-
ctions and, thus, facilitate decrease of their prevalence in the ICU by maintaining a high level of hy-
giene in the hospital. In this way, a timely and proper treatment of infections occurring in the ICUs,
and generally in the whole hospital, is achievable.

Key words
ICU infections, classification of infections,
microbiological carrier status.

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×. ÔÑÉÊÁËÉÙÔÇÓ, Â. ÓÏÕËÏÕÍÔÆÇ, Å. ÊÁÔÓÉÖÁ ÊÁÉ ÓÕÍ.
Âéâëéïãñáößá
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34. Gastmeier P, Geffers C, Brandt C, Zuschneid I, Sohr D, Schwab
F, et al. Effectiveness of a nationwide nosocomial infection surveil-
lance system for reducing nosocomial infections. J Hosp Infect
2006; 64: 16-22.
6-ereunitiki.qxd 14/10/2009 2:40 Page 209

ÅñåõíçôéêÞ Åñãáóßá

Áîéïëüãçóç ðÝíôå åìðïñéêþí äïêéìáóéþí ôá÷åßáò ôáõôïðïßçóçò ôïõ

Staphylococcus aureus

Ê. Ôóéâåñéþôçò1,2, Ê.Ó. ×áôæçãåùñãßïõ2, Ê. ÆïõñéäÜêç1, Ó. ÊùíóôáíôïõëÜêç1, Ë. ÆÝñâá2, Ï. ÐáíéÜñá1,

Á. Áñãõñïðïýëïõ1
1ÅñãáóôÞñéï Ìéêñïâéïëïãßáò Ã.Í.Á. “ï Åõáããåëéóìüò”, ÁèÞíá
2ÅñãáóôÞñéï ÊëéíéêÞò Ìéêñïâéïëïãßáò, Ðáíåðéóôçìéáêü Ãåíéêü Íïóïêïìåßï “Áôôéêüí”, ÉáôñéêÞ Ó÷ïëÞ, ÐáíåðéóôÞìéï
Áèçíþí, ×áúäÜñé

Ðåñßëçøç
209

Ç äïêéìáóßá áíß÷íåõóçò óõíäåäåìÝíçò ðçêôÜóçò óå ðëÜêá åßíáé ç ôá÷ýôåñç ìÝèïäïò ôáõôïðïßç-

óçò åíüò óôåëÝ÷ïõò óôáöõëïêüêêïõ ùò S. aureus. Óêïðüò ôçò ðáñïýóáò ìåëÝôçò åßíáé ç áîéïëü-
ãçóç ôùí áðïôåëåóìÜôùí ðÝíôå åìðïñéêþí äïêéìáóéþí ôáõôïðïßçóçò ôïõ S. aureus. ÌåëåôÞèçêáí
113 óôåëÝ÷ç óôáöõëüêïêêùí, ðïõ áðïìïíþèçêáí áðü ðïéêßëá êëéíéêÜ äåßãìáôá éóÜñéèìùí áóèåíþí
êáé äéáôçñÞèçêáí óå èåñìïêñáóßá -70ïC. Ôá óôåëÝ÷ç ôáõôïðïéÞèçêáí ìå PCR ôïõ ãïíéäßïõ tuf êáé
Ýðåéôá ðÝøç ìå ðåñéïñéóôéêÞ åíäïíïõêëåÜóç Þ/êáé ìå ìåñéêÞ áëëçëïý÷çóç ôïõ ãïíéäßïõ ôïõ 16S
rRNA, ùò åîÞò: S. aureus (47), S. epidermidis (40), S. hominis (11), S. lugdunensis (5), S. haemoly-
ticus (5), S. sciuri (2), S. simulans (1) êáé S. cohnii (2). Ï Ýëåã÷ïò ãéá ôç äéÜêñéóç ôùí óôåëå÷þí S.
aureus äéåíåñãÞèçêå ìå ôéò åìðïñéêÝò äïêéìáóßåò Staphaurex Plus (Remel, Europe Ltd, Kent UK),
Staphaurex (Remel, Europe Ltd, Kent UK), BBL Staphyloslide (Becton Dickinson and Company,
Sparks, USA), Staphytect Plus (Oxoid Ltd, Basingstoke, Hants, UK) êáé Slidex Staph Plus (bioMé-
rieux S.A., Marcy l' Etoile, France), óýìöùíá ìå ôéò ïäçãßåò ôùí êáôáóêåõáóôþí. Ôá ðïóïóôÜ åõáé-
óèçóßáò êáé åéäéêüôçôáò áíôßóôïé÷á ôïõ êÜèå áíôéäñáóôçñßïõ åß÷áí ùò åîÞò: 100% êáé 87,9% ãéá ôï
Staphaurex Plus, 97,8% êáé 100% ãéá ôï Staphaurex, 100% êáé 93,9% ãéá ôï BBL Staphyloslide,
100% êáé 80,3% ãéá ôï Staphytect Plus êáé 100% êáé 97,0% ãéá ôï Slidex Staph Plus. Ç áíÜãíùóç
ôùí áðïôåëåóìÜôùí Ýãéíå ðåñéóóüôåñï åõ÷åñþò ìå ôá Staphaurex êáé Slidex Staph Plus. Óôá õðü-
ëïéðá ôåóô, éäßùò ôï Staphytect Plus, õðÞñîáí äõóêïëßåò óôçí åñìçíåßá ôùí áðïôåëåóìÜôùí ëüãù
åìöÜíéóçò ïñéóìÝíùí ìç åéäéêþí óõãêïëëÞóåùí. Øåõäþò èåôéêÜ áðïôåëÝóìáôá ðáñáôçñÞèçêáí ìü-
íï ìåôáîý ôùí ðçêôÜóçò áñíçôéêþí óôáöõëïêüêêùí êáé óõãêåêñéìÝíá óå ïñéóìÝíá óôåëÝ÷ç S. epi-
dermidis Þ S. lugdunensis. ÓõìðåñáóìáôéêÜ, óå üëá ôá õðü Ýëåã÷ï ôåóô êáôáãñÜöçêå Üñéóôç
åõáéóèçóßá, åíþ ôá Staphaurex êáé Slidex Staph Plus åß÷áí ôçí õøçëüôåñç åéäéêüôçôá êáé äåí åìöÜ-

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
6-ereunitiki.qxd 14/10/2009 2:40 Page 210
Ê. ÔÓÉÂÅÑÉÙÔÇÓ, Ê.Ó. ×ÁÔÆÇÃÅÙÑÃÉÏÕ, Ê. ÆÏÕÑÉÄÁÊÇ ÊÁÉ ÓÕÍ.
íéóáí áìößâïëá áðïôåëÝóìáôá. Ç ôáõôïðïßçóç ôùí óôåëå÷þí S. aureus ìå ôç ÷ñÞóç ôá÷Ýùí åìðï-
ñéêþí äïêéìáóéþí áðáéôåß åìðåéñßá ãéá ôçí åñìçíåßá ôùí áðïôåëåóìÜôùí êáé ãíþóç ôùí éäéáéôåñï-
ôÞôùí ôùí ÷ñçóéìïðïéïõìÝíùí åìðïñéêþí ðñïúüíôùí.
ËÝîåéò êëåéäéÜ
Óôáöõëüêïêêïé, ðçêôÜóç,
ôá÷åßåò ìÝèïäïé.
ÅéóáãùãÞ
O Staphylococcus aureus åßíáé Ýíá áðü ôá óõ÷íüôå-
ñá ðáèïãüíá ãéá ôïí Üíèñùðï êáé áðïôåëåß áéôéïëï-
ãéêü ðáñÜãïíôá ãéá åõñý öÜóìá ëïéìþîåùí, ðïõ
Ý÷ïõí óõ÷íÜ õøçëÞ íïóçñüôçôá. Åßíáé, ëïéðüí, öáíå-
ñÞ ç áíÜãêç ãéá ìéá ãñÞãïñç, áîéüðéóôç, áðëÞ êáé
ôáõôü÷ñïíá öèçíÞ ìÝèïäï äéÜêñéóçò ôïõ S. aureus
áðü ôïõò ðçêôÜóç-áñíçôéêïýò óôáöõëüêïêêïõò (Co-
agulase-negative staphylococci, CNS).1
Ç äïêéìáóßá áíß÷íåõóçò ôçò åëåýèåñçò ðçêôÜóçò
(free coagulase-tube test) áðïôåëåß ôçí êáëýôåñç ìÝ-
èïäï äéÜêñéóçò ôïõ S. aureus áðü ôïõò CNS, áëëÜ
ìåéïíåêôåß ùò ðñïò ôï ÷ñüíï ðïõ áðáéôåß ãéá ôçí åîá-
ãùãÞ ôïõ ôåëéêïý áðïôåëÝóìáôïò, ï ïðïßïò êõìáßíå-
ôáé áðü 4 Ýùò 24 þñåò. ÁíôéèÝôùò, ìéá ôá÷åßá
äïêéìáóßá, ðïõ ÷ñçóéìïðïéåßôáé åõñýôáôá óôá åñãá-
210 óôÞñéá êëéíéêÞò ìéêñïâéïëïãßáò, åßíáé ç, åðß ðëáêüò,
áíß÷íåõóç ôçò óõíäåäåìÝíçò ðçêôÜóçò (clumping fa-
ctor-slide test), ìå ÷ñüíï åîáãùãÞò ôïõ áðïôåëÝóìá-
ôïò <1 ëåðôü. Ç óõíäåäåìÝíç ðçêôÜóç âñßóêåôáé óôï
ôïß÷ùìá ôïõ S. aureus êáé ìåôáôñÝðåé áðåõèåßáò ôï
éíùäïãüíï óå áäéÜëõôç éíéêÞ, óå áíôßèåóç ìå ôçí
åëåýèåñç ðçêôÜóç ðïõ óõíäÝåôáé ðñþôá ìå ìéá óöáé-
ñßíç ôïõ ðëÜóìáôïò (coagulase reacting factor), ãéá
íá ó÷çìáôéóèåß Ýíá óýìðëåãìá ðïõ ìåôáôñÝðåé ôï
éíùäïãüíï óå éíéêÞ.2
Áñ÷éêÜ, ãéá ôçí áíß÷íåõóç ôçò óõíäåäåìÝíçò ðç-
êôÜóçò åß÷áí ÷ñçóéìïðïéçèåß åñõèñïêýôôáñá åõáéóèç-
ôïðïéçìÝíá ìå éíùäïãüíï. Áñãüôåñá, áíáðôý÷èçêáí
ôá ðñïúüíôá äåýôåñçò ãåíéÜò, ðïõ ðåñéåëÜìâáíáí óù-
ìáôßäéá latex Þ åõáéóèçôïðïéçìÝíá åñõèñïêýôôáñá
ðñïâÜôïõ, ãéá ôçí ôáõôü÷ñïíç áíß÷íåõóç ôçò óõíäåäå-
ìÝíçò ðçêôÜóçò êáé ôçò ðñùôåÀíçò Á ôïõ S. aureus.
Ðáñüôé ôá ðñïúüíôá áõôÜ óôçí áñ÷Þ öáßíïíôáí éäéáß-
ôåñá áîéüðéóôá, óýíôïìá õðÞñîáí áíáöïñÝò ãéá øåõ-
äþò áñíçôéêÜ áðïôåëÝóìáôá, êõñßùò áðü óôåëÝ÷ç S.
aureus áíèåêôéêïý óôçí ìåèéêéëëßíç (methicillin resistant
S. aureus – MRSA). Ç áíÜãêç, ëïéðüí, ãéá áýîçóç ôçò
åõáéóèçóßáò êáé ôçò åéäéêüôçôáò ïäÞãçóå óôá ðñïúü-
íôá ôñßôçò ãåíéÜò ðïõ ðåñéëáìâÜíïõí, åðéðëÝïí, áíôé-
VOL. 54 • ISSUE 4, July - August 2009
Yðåýèõíïò áëëçëïãñáößáò
ÁèçíÜ Áñãõñïðïýëïõ
ÅñãáóôÞñéï Ìéêñïâéïëïãßáò,
ÃÍÁ "Ï Åõáããåëéóìüò",
Ôçë.: 210-7217704
e-mail: gatzea@otenet.gr
óþìáôá Ýíáíôé ðïëõóáê÷áñéôþí Þ Üëëùí åéäéêþí áíôé-
ãüíùí ôçò åðéöÜíåéáò ôïõ S. aureus.3
Óêïðüò ôçò ðáñïýóáò ìåëÝôçò Þôáí ç áîéïëüãçóç
ðÝíôå åìðïñéêþí êéô ôá÷åßáò áíß÷íåõóçò óõíäåäåìÝ-
íçò ðçêôÜóçò, óå äéÜöïñá åßäç óôáöõëüêïêêùí.
ÕëéêÜ êáé ÌÝèïäïé
ÌåëåôÞèçêáí 113 ôõ÷áßá åðéëåãìÝíá êëéíéêÜ óôåëÝ÷ç
óôáöõëüêïêêùí áðü ôç óõëëïãÞ ìéêñïâßùí ôïõ Åñ-
ãáóôçñßïõ ÊëéíéêÞò Ìéêñïâéïëïãßáò ðïõ áðïìïíþèç-
êáí áðü éóÜñéèìïõò áóèåíåßò ôïõ Ðáíåðéóôçìéáêïý
Íïóïêïìåßïõ "Áôôéêüí". Áíáëõôéêüôåñá, åîåôÜóôçêáí
47 óôåëÝ÷ç S. aureus êáé 66 óôåëÝ÷ç CNS (40 S. epi-
dermidis, 11 S. hominis, 5 S. lugdunensis, 5 S. haemo-
lyticus, 2 S. sciuri, 2 S. conhii êáé 1 S. simulans). Ôá
óôåëÝ÷ç ôáõôïðïéÞèçêáí ìå PCR ãéá ôï ãïíéäßïõ tuf
êáé ðÝøç ôïõ ðñïúüíôïò ìå ðåñéïñéóôéêÞ åíäïíïõêëå-
Üóç (Restriction Fragment Length Polymorphism –
RFLP).4 ÅéäéêÜ ãéá óôåëÝ÷ç ôùí åéäþí S. epidermidis
êáé S. hominis ÷ñçóéìïðïéÞèçêå åðéâåâáéùôéêÜ êáé ç
ìåñéêÞ áëëçëïý÷çóç ôïõ 16S rRNA ãïíéäßïõ.5
Óôçí ðáñïýóá ìåëÝôç, ðÝíôå áíôéäñáóôÞñéá ðïõ
äéáôßèåíôáé óôï åìðüñéï áîéïëïãÞèçêáí ãéá ôçí éêá-
íüôçôÜ ôïõò íá äéáêñßíïõí ôïí ÷ñõóßæïíôá áðü ôïõò
ðçêôÜóç-áñíçôéêïýò óôáöõëïêüêêïõò. Áðü ôç "äåý-
ôåñç ãåíéÜ" áíôéäñáóôçñßùí ÷ñçóéìïðïéÞèçêáí ôá
Staphaurex (Remel, Europe Ltd, Kent UK) êáé BBL
Staphyloslide (Becton Dickinson and Company,
Sparks, USA), ìå óôü÷ï ôçí áíß÷íåõóç ôçò óõíäåäå-
ìÝíçò ðçêôÜóçò êáé ôçò ðñùôåÀíçò Á ôïõ S. aureus
ìÝóù óõãêüëëçóçò óùìáôéäßùí latex åõáéóèçôïðïéç-
ìÝíùí ìå áíèñþðéíï éíùäïãüíï êáé IgG. Áðü ôá "ôñß-
ôçò ãåíéÜò" ðñïúüíôá óôçí áîéïëüãçóç
óõìðåñéëÞöèçêáí ôá Stauphaurex Plus (Remel, Euro-
pe Ltd, Kent UK), Staphytect Plus (Oxoid, Oxoid Ltd,
Basingstoke, Hants, UK), êáé Slidex Staph Plus (bio-
Merieux S.A., Marcy l'Etoile, France), ôá ïðïßá äéáèÝ-
ôïõí ôç äõíáôüôçôá áíß÷íåõóçò ôçò óõíäåäåìÝíçò
ðçêôÜóçò, ôçò ðñùôåÀíçò Á êáé åéäéêþí áíôéãüíùí åðé-
öáíåßáò ôïõ S. aureus ìÝóù óõãêüëëçóçò óùìáôéäß-
6-ereunitiki.qxd 14/10/2009 2:40 Page 211

ÁÎÉÏËÏÃÇÓÇ ÐÅÍÔÅ ÅÌÐÏÑÉÊÙÍ ÄÏÊÉÌÁÓÉÙÍ

?????? ?????? ????????ÔÁ×ÅÉÁÓ ÔÁÕÔÏÐÏÉÇÓÇÓ
???? ??????? ÔÏÕ STAPHYLOCOCCUS
???????????? AUREUS
??? Blastocystis sp.

ùí latex åðåíäõìÝíùí ìå áíèñþðéíï éíùäïãüíï êáé Óýãêñéóç ôùí áðïôåëåóìÜôùí ôùí ðÝíôå åìðïñéêþí
IgG. äïêéìáóéþí óå 47 ìïñéáêÜ åðéâåâáéùìÝíá óôåëÝ÷ç
Ôá óôåëÝ÷ç óõíôçñÞèçêáí óôïõò -70ïC, óå èñå- Ðßíáêáò 1 Staphylococcus aureus.
ðôéêü æùìü ìå 10% ãëõêåñüëç. Ðñéí ôç äéåíÝñãåéá
Øåõäþò
ôùí äïêéìáóéþí ãßíïíôáí äõï äéáäï÷éêÝò áíáêáëëéÝñ-
ÈåôéêÜ áñíçôéêÜ Åõáéóèçóßá
ãåéåò óå áéìáôïý÷ï Üãáñ. Ïé äïêéìáóßåò Ýãéíáí áêï-
ëïõèþíôáò óå êÜèå ðåñßðôùóç ôéò ïäçãßåò ôçò Staphaurex Plus 47 0 100%
êáôáóêåõÜóôñéáò åôáéñåßáò. Staphaurex 46 1 97,8%
Ç åêôÝëåóç ôùí äïêéìáóéþí Ýãéíå óôï åñãáóôÞñéï Staphyloslide 47 0 100%
Staphytect Plus 47 0 100%
ÊëéíéêÞò Ìéêñïâéïëïãßáò ôïõ ÃÍÁ "Ï Åõáããåëéóìüò",
Slidex Staph Plus 47 0 100%
áðü åéäéêåõüìåíï éáôñü, üðùò ãßíåôáé óôçí êáèçìå-
ñéíÞ ñïõôßíá ôïõ åñãáóôçñßïõ. Óôçí ðåñßðôùóç áì-
öéâïëéþí óôçí áíÜãíùóç ôïõ áðïôåëÝóìáôïò
áêïëïõèïýóå åðáíÜëçøç ìå áîéïëüãçóç ôïõ áðïôå- Ìåôáîý ôùí CNS, øåõäþò èåôéêÜ áðïôåëÝóìáôá
ëÝóìáôïò áðü åéäéêåõìÝíï éáôñü. Ôá áðïôåëÝóìáôá óôéò äïêéìáóßåò óõãêüëëçóçò Ýäùóáí ôá åßäç S. epi-
ôçò ìïñéáêÞò ôáõôïðïßçóçò äåí Þôáí ãíùóôÜ óôïí dermidis êáé S. lugdunensis (Ðßíáêáò 3). Áðü ôá 40
åîåôáóôÞ êáôÜ ôï ÷ñüíï äéåíÝñãåéáò ôùí äïêéìáóéþí óôåëÝ÷ç S. epidermidis ðïõ åîåôÜóôçêáí, ôá 25 Þôáí
óõãêüëëçóçò. áñíçôéêÜ ìå üëá ôá ôåóô. Øåõäþò èåôéêÜ áðïôåëÝ-
Ãéá êÜèå Ýíá áðü ôá ðáñáðÜíù áíôéäñáóôÞñéá êá- óìáôá óå Ýíá ìüíï ôåóô Ýäùóáí 10 óôåëÝ÷ç (7 óôï
ôáãñÜöçêå ç åõáéóèçóßá êáé ç åéäéêüôçôá. Staphytect Plus êáé 3 óôï Staphaurex Plus), 3 óôåëÝ-
÷ç óå äýï ôåóô (2 óôï Staphytect Plus êáé ôï Staphy-
loslide êáé 1 óôï Staphytect Plus êáé ôï Staphaurex
ÁðïôåëÝóìáôá Plus) êáé 1 óôÝëå÷ïò óå ôÝóóåñá ôåóô (óôá Staphau-
¼ëá ôá ôåóô ãéá ôçí ôá÷åßá áíß÷íåõóç ôçò óõíäåäåìÝ- rex Plus, Staphyloslide, Staphytect Plus êáé Slidex
íçò ðçêôÜóçò ðïõ áîéïëïãÞèçêáí Þôáí åýêïëá óôçí Staph Plus). Áðü ôá 5 óôåëÝ÷ç S. lugdunensis, ôá 2
åöáñìïãÞ êáé Ýäéíáí áðïôåëÝóìáôá ìåôÜ áðü 20 Ýùò Þôáí áñíçôéêÜ óå üëá ôá ôåóô, 1 óôÝëå÷ïò Þôáí øåõ-
60 äåõôåñüëåðôá. Ùóôüóï, ìåñéêÜ áðü ôá óôåëÝ÷ç äþò èåôéêü óå Ýíá ôåóô (Staphaurex Plus), 1 óôÝëå-
ðïõ åîåôÜóèçêáí äåí Þôáí ðÜíôá åýêïëï íá áîéïëï- ÷ïò Þôáí èåôéêü óå 2 ôåóô (Staphaurex Plus êáé
ãçèïýí, ðáñÜãïíôáò êÜðïéåò öïñÝò áìößâïëá áðïôå- Staphytect Plus), åíþ õðÞñ÷å êáé 1 óôÝëå÷ïò èåôéêü
ëÝóìáôá. Ôï Staphytect Plus åìöÜíéóå 11 áìößâïëá óå 4 ôåóô (Staphaurex Plus, Staphyloslide, Staphytect
áðïôåëÝóìáôá, ôá ïðïßá áöïñïýóáí 5 óôåëÝ÷ç S. epi- Plus êáé Slidex Staph Plus).
dermidis, 4 óôåëÝ÷ç S. haemolyticus êáé 2 óôåëÝ÷ç S.
hominis. Óôï Staphyloslide, 2 óôåëÝ÷ç (1 S. epidermi- 211
dis êáé 1 S. hominis) êáé óôï Staphaurex Plus 1 óôÝëå- ÓõæÞôçóç
÷ïò S. epidermidis Ýäùóáí áìößâïëá áðïôåëÝóìáôá. Ç äïêéìáóßá åëåýèåñçò ðçêôÜóçò, ç ìÝèïäïò åêëï-
Ôá ßäéá áðïôåëÝóìáôá åß÷å äþóåé ãéá ôá ßäéá óôåëÝ÷ç ãÞò ãéá ôçí äéÜêñéóç ôïõ ÷ñõóßæïíôá áðü ôïõò ðç-
êáé ôï Staphytect Plus. ¼ëá ôá áìößâïëá áðïôåëÝóìá- êôÜóç-áñíçôéêïýò óôáöõëïêüêêïõò, äåí Ý÷åé ôý÷åé
ôá, êáôÜ ôá ïðïßá åìöáíéæüôáí ìç åéäéêü äßêôõï óõ- åõñåßáò åöáñìïãÞò ëüãù ôïõ ìáêñïý ÷ñüíïõ ðïõ
ãêüëëçóçò, ÷ùñßò äéáýãáóç ôïõ ÷ñþìáôïò ôïõ latex, áðáéôåßôáé ãéá ôï ôåëéêü áðïôÝëåóìá. ÁíôéèÝôùò, ôá
êáôÜ ôçí äåýôåñç áîéïëüãçóç åñìçíåýôçêáí êáé êá- åìðïñéêÜ ôåóô ôá÷åßáò áíß÷íåõóçò ôçò óõíäåäåìÝ-
ôá÷ùñÞèçêáí ùò áñíçôéêÜ. Äåí ðáñáôçñÞèçêáí ðñï- íçò ðçêôÜóçò, ÷ñçóéìïðïéïýíôáé åõñÝùò óôçí êá-
âëÞìáôá óôçí áíÜãíùóç êáé áîéïëüãçóç ôùí èçìåñéíÞ ðñáêôéêÞ óôá åñãáóôÞñéá êëéíéêÞò
óõãêïëëÞóåùí ìå ôá Staphaurex êáé Slidex Staph ìéêñïâéïëïãßáò.6
Plus.
Óå üëá ôá ôåóô êáôáãñÜöçêå Üñéóôç åõáéóèçóßá,
óå ðïóïóôÜ ðïõ êõìÜíèçêáí áðü 97,8-100%. Óõãêå- Óýãêñéóç ôùí áðïôåëåóìÜôùí ôùí ðÝíôå åìðïñéêþí
êñéìÝíá ôá Staphaurex Plus, Staphyloslide, Staphytect äïêéìáóéþí óå 66 ìïñéáêÜ åðéâåâáéùìÝíá óôåëÝ÷ç
Ðßíáêáò 2 coagulase negative Staphylococci.
Plus êáé Slidex Staph Plus ôáõôïðïßçóáí óùóôÜ êáé
ôá 47 óôåëÝ÷ç S. aureus, åíþ ôï Staphaurex ôáõôï- Øåõäþò
ðïßçóå óùóôÜ ôá 46 (1 øåõäþò áñíçôéêü áðïôÝëåóìá, Ðñïúüí ÁñíçôéêÜ èåôéêÜ Åéäéêüôçôá
Ðßíáêáò 1).
Staphaurex Plus 58 8 87,9%
Ãéá ôï Staphaurex êáôáãñÜöçêå åéäéêüôçôá 100%,
Staphaurex 66 0 100%
ãéá ôï Slidex Staph Plus 97,0% êáé ãéá ôï Staphylosli- Staphyloslide 62 4 93,9%
de 93,9%. Áíôßèåôá, ãéá ôá Üëëá äýï ðñïúüíôá ç åéäé- Staphytect Plus 53 13 80,3%
êüôçôá Þôáí ìç éêáíïðïéçôéêÞ, ìå ðïóïóôÜ êÜôù áðü Slidex Staph Plus 64 2 97,0%
90% (Ðßíáêáò 2).

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Ê. ÔÓÉÂÅÑÉÙÔÇÓ, Ê.Ó. ×ÁÔÆÇÃÅÙÑÃÉÏÕ, Ê. ÆÏÕÑÉÄÁÊÇ ÊÁÉ ÓÕÍ.
Øåõäþò èåôéêÜ áðïôåëÝóìáôá óôéò äïêéìáóßåò óõãêüëëçóçò óôïõò coagulase negative Staphylococci (CNS).
Ðßíáêáò 3
Áñéèìüò Øåõäþò Staphaurex
Åßäïò óôåëå÷þí èåôéêÜ
S. epidermidis 40 15
S. lugdunensis 5 3
Ëïéðïß CNS 21 0 0
Óýíïëï 66 18
Óôçí ðáñïýóá ìåëÝôç áîéïëïãÞóáìå ôá áðïôåëÝ-
óìáôá 5 åìðïñéêþí äïêéìáóéþí ôá÷åßáò áíß÷íåõóçò
óõíäåäåìÝíçò ðçêôÜóçò. Ôá "Staphaurex" êáé
"Staphyloslide" áíôéðñïóþðåõáí ôåóô 2çò ãåíéÜò, åíþ
ôá"Staphaurex Plus", "Staphytect Plus" êáé "Slidex
Staph Plus" áíôéðñïóþðåõáí ôá ôåóô 3çò ãåíéÜò, ðïõ
åðéðëÝïí áíé÷íåýïõí åðéöáíåéáêÜ áíôéãüíá ôïõ S. au-
reus, óõìâÜëëïíôáò Ýôóé, èåùñçôéêÜ, óôçí áíáãíþñé-
óç óôåëå÷þí, éäßùò MRSA, ðïõ äåí åêöñÜæïõí
óõíäåäåìÝíç ðçêôÜóçò Þ ðñùôåÀíç Á.6 ÅëÝã÷èçêáí
óôåëÝ÷ç ðïõ áíÞêáí óå 8 åßäç óôáöõëïêüêêùí (S. au-
reus êáé 7 åßäç CNS). Ç ôáõôïðïßçóç ôùí óôåëå÷þí
óå åðßðåäï åßäïõò Ýãéíå ìå ìïñéáêÝò ôå÷íéêÝò ðïõ
áðïôåëïýí ìÝèïäï áíáöïñÜò. Ùò ìåéïíÝêôçìá ôçò
ìåëÝôçò ìðïñåß íá èåùñçèåß ï ìéêñüò áñéèìüò óôå-
ëå÷þí ðïõ åîåôÜóôçêáí êáé ç ìç áíß÷íåõóç ôùí óôå-
ëå÷þí MRSA ìåôáîý ôùí S. aureus.
Áðü ôç ìåëÝôç ôùí áðïôåëåóìÜôùí ðñïêýðôåé ðùò
üëá ôá ôåóô (2çò êáé 3çò ãåíéÜò) åìöÜíéóáí åîáéñåôé-
êÞ åõáéóèçóßá (97,8-100%). Ìüíï ôï "Staphaurex",
212
ôåóô 2çò ãåíéÜò, äåí áíáãíþñéóå Ýíá óôÝëå÷ïò S. au-
reus. Åîßóïõ õøçëÜ ðïóïóôÜ åõáéóèçóßáò êáôáãñÜ-
öïíôáé êáé óôç äéåèíÞ âéâëéïãñáößá, éäéáßôåñá ãéá
åõáßóèçôá óôç ìåèéêéëëßíç óôåëÝ÷ç S. aureus. ÌåëÝ-
ôåò ðïõ óõìðåñéëáìâÜíïõí áíèåêôéêÜ óôåëÝ÷ç êáôá-
ëÞãïõí óå ÷áìçëüôåñåò åõáéóèçóßåò ìÝ÷ñé êáé 75%,
åéäéêÜ óôá ðñïúüíôá ðñþôçò êáé äåýôåñçò ãåíéÜò.6-9
Åßíáé ãíùóôü ðùò óôá óôåëÝ÷ç MRSA ìðïñåß íá ìçí
åêöñÜæåôáé ï ðáñÜãïíôáò èñüìâïõ Þ ç ðñùôåÀíç
Á6,7,10 Þ ìðïñåß ç ðáñïõóßá ôïõ ðïëõóáê÷áñßôç åðé-
öÜíåéáò 5, óå ðïóïóôü Ýùò 84%, íá "êñýâåé" ôéò ðá-
ñáðÜíù äïìÝò.10-12 Ôá ôåóô 3çò ãåíéÜò ìðïñïýí íá
áíé÷íåýïõí åéäéêÜ áíôéãüíá ôïõ S. aureus, óõìðåñé-
ëáìâáíïìÝíùí êáé ôùí ðïëõóáê÷áñéôþí 5 êáé 8 ðïõ
åêöñÜæïíôáé óå ðïóïóôü Ýùò 80% ôùí óôåëå÷þí êáé
Ýôóé ìåéþíåôáé, èåùñçôéêÜ, ç ðéèáíüôçôá øåõäþò áñ-
íçôéêþí áðïôåëåóìÜôùí.10-12
Áðü ôïõò ðçêôÜóç-áñíçôéêïýò óôáöõëïêüêêïõò
ðïõ áðïìïíþíïíôáé óå êëéíéêÜ äåßãìáôá, ãéá ôá åßäç
S. lugdunensis êáé S. schleiferi Ý÷åé ðåñéãñáöåß ç ðá-
ñáãùãÞ åíüò ðáñÜãïíôá óõíáöïýò ìå ôï éíùäïãüíï
(fibrinogen affinity factor), óôïí ïðïßï ðéèáíþò áðïäß-
äåôáé ç åìöÜíéóç øåõäþò èåôéêÞò åðß ðëáêüò äïêéìá-
VOL. 54 • ISSUE 4, July - August 2009
Øåõäþò èåôéêÜ áðïôåëÝóìáôá áíÜ ðñïúüí
Staphytect Slidex
Plus Staphaurex Staphyloslide Plus Staph Plus
5 0 3 11 1
3 0 1 2 1
0 0 0 0
8 0 4 13 2
óßáò ðçêôÜóçò.13 O óõãêåêñéìÝíïò öáéíüôõðïò äåí
åêöñÜæåôáé óôáèåñÜ áðü üëá ôá óôåëÝ÷ç ôùí åéäþí
áõôþí, ùóôüóï èá ðñÝðåé íá åßíáé ãíùóôüò óôïí êëé-
íéêü Ìéêñïâéïëüãï, þóôå íá áðïöåýãåôáé åíäå÷üìå-
íç óýã÷õóç êáôÜ ôçí ôáõôïðïßçóç ìå ôïí S. aureus.
ÅéäéêÜ ãéá ôï åßäïò S. lugdunensis ðïõ óõìðåñéëÞöèç-
êå óôçí ðáñïýóá ìåëÝôç, Ý÷åé ÷áñáêôçñéóôåß ç Fbl
ðñùôåßíç (Fibrinogen binding protein of S. lugdunen-
sis), ðïõ óõíäÝåôáé óôçí ßäéá ðåñéï÷Þ ôçò ã-áëõóßäáò
ôïõ éíùäïãüíïõ, áíÞêåé óôçí ßäéá ïéêïãÝíåéá (Sdr) êáé
Ý÷åé ðáñüìïéá áëëçëïõ÷ßá êáé äïìéêÞ ïñãÜíùóç ìå
ôïí clumping factor A ôïõ S. aureus.14 Óôçí ðñùôåÀíç
áõôÞ, ìå ôï ãïíßäéï fbl ðïõ ôçí êùäéêïðïéåß íá áíåõ-
ñßóêåôáé óå üëá ôá óôåëÝ÷ç ôïõ åßäïõò, ïöåßëåôáé ç
èåôéêÞ äïêéìáóßá óõíäåäåìÝíçò ðçêôÜóçò ðïõ åßíáé
ðéèáíüí íá ðáñáôçñçèåß, áí êáé ç äéáöïñåôéêÞ éêáíü-
ôçôá ôùí äéáöüñùí äïêéìáóéþí íá ôçí áíé÷íåýóïõí,
ó÷åôßæåôáé åßôå ìå ðïéêéëßá óôï åðßðåäï ôçò ÝêöñáóÞò
ôçò áíÜìåóá óôá óôåëÝ÷ç Þ ìå ðáñÜãïíôåò ðïõ áöï-
ñïýí ôçí áíáëõôéêÞ åõáéóèçóßá ôùí ßäéùí ôùí áíôé-
äñáóôçñßùí. Óôçí ðáñïýóá ìåëÝôç ôï ðïóïóôü ôùí
èåôéêþí óôåëå÷þí S. lugdunensis óôéò äïêéìáóßåò óõ-
ãêüëëçóçò êõìÜíèçêå áðü 0-60%, ìå ôá áíôßóôïé÷á
ðïóïóôÜ óôç âéâëéïãñáößá íá åßíáé 0-100%, áíÜëïãá
ìå ôï åßäïò ôïõ åìðïñéêïý áíôéäñáóôçñßïõ ðïõ áîéï-
ëïãåßôáé.3,6,12 Ôï õøçëü ðïóïóôü èåôéêþí áðïôåëå-
óìÜôùí ãéá ôï Staphaurex Plus åßíáé åýñçìá ðïõ
óõìöùíåß ìå ðñïçãïýìåíåò áíáöïñÝò, üðïõ áõôü
êõìáßíåôáé áðü 60-100%.3,6
ÁíáöïñéêÜ ìå ôá øåõäþò èåôéêÜ áðïôåëÝóìáôá
ôïõ åßäïõò S. epidermidis, áõôÜ Ý÷ïõí áðïäïèåß óôçí
ýðáñîç åíüò áíôéãüíïõ (ïñïôýðïõ 18) ðïõ äßíåé äéá-
óôáõñïýìåíç áíôßäñáóç ìå ôá áíôéóþìáôá êáôÜ ôùí
ðïëõóáê÷áñéôþí åðéöáíåßáò.15 ÂÝâáéá, ãéá ôï óõãêå-
êñéìÝíï åßäïò Ý÷åé ðåñéãñáöåß êáé ç Fbe ðñùôåÀíç (Fi-
brinogen binding protein of S. epidermidis) ðïõ
óõíäÝåôáé ìå ôï éíùäïãüíï, ÷ùñßò üìùò íá Ý÷åé óá-
öþò óõó÷åôéóèåß ìå ðéèáíÜ èåôéêÜ áðïôåëÝóìáôá óôéò
äïêéìáóßåò óõíäåäåìÝíçò ðçêôÜóçò.16 Åðßóçò, áîßæåé
íá óçìåéùèåß üôé óôç âéâëéïãñáößá áíáöÝñåôáé ç ðá-
ñïõóßá ðñùôåÀíçò Á, óôçí ïðïßá óôï÷åýïõí ôá IgG
áíôéóþìáôá ðïõ ðåñéÝ÷ïíôáé óôá áíôéäñáóôÞñéá, óå
ðïóïóôü ðåñßðïõ 2% ôùí CNS.17
6-ereunitiki.qxd 14/10/2009 2:40 Page 213

ÁÎÉÏËÏÃÇÓÇ ÐÅÍÔÅ ÅÌÐÏÑÉÊÙÍ ÄÏÊÉÌÁÓÉÙÍ

?????? ?????? ????????ÔÁ×ÅÉÁÓ ÔÁÕÔÏÐÏÉÇÓÇÓ
???? ??????? ÔÏÕ STAPHYLOCOCCUS
???????????? AUREUS
??? Blastocystis sp.

¼ëá ôá õðü áîéïëüãçóç áíôéäñáóôÞñéá åß÷áí åîáé-
ñåôéêÞ áðüäïóç áðü ðëåõñÜò åõáéóèçóßáò, åíþ óôï
óõíäõáóìü åõáéóèçóßáò-åéäéêüôçôáò õðåñåß÷áí ôá
Staphaurex êáé Slidex Staph Plus. Ìå ôçí åîáßñåóç ôïõ
Staphytect Plus ç áíÜãíùóç ôùí áðïôåëåóìÜôùí Ýãé-
íå ìå åõ÷Ýñåéá óôéò ðåñéóóüôåñåò ôùí ðåñéðôþóåùí.
Óýìöùíá ëïéðüí ìå ôá äéåèíÞ âéâëéïãñáöéêÜ äå-
äïìÝíá, ç äïêéìáóßá ôçò åëåýèåñçò ðçêôÜóçò ðáñá-
ìÝíåé ç ìÝèïäïò áíáöïñÜò ãéá ôç äéÜêñéóç ôùí
ðçêôÜóç-áñíçôéêþí óôáöõëüêïêêùí áðü ôïí S. au-
reus. ÊáôÜ óõíÝðåéá, ôá åñãáóôÞñéá ðïõ óõìðåñéëáì-
âÜíïõí óôï äéáãíùóôéêü áëãüñéèìï ñïõôßíáò áðï-
êëåéóôéêÜ ôçí åðß ðëáêüò ìÝèïäï èá ðñÝðåé íá áîéï-
ëïãïýí ìå ðñïóï÷Þ ôá áðïôåëÝóìáôÜ ôçò. ÐéèáíÜ
øåõäþò èåôéêÜ áðïôåëÝóìáôá áðü óôåëÝ÷ç CNS êáé
ðéèáíÜ øåõäþò áñíçôéêÜ áðïôåëÝóìáôá áðü óôåëÝ-
÷ç ÌRSA, èá ðñÝðåé íá åëÝã÷ïíôáé ðåñáéôÝñù êáé íá
ëáìâÜíïíôáé õðüøç ðÜíôá óå óõíäõáóìü êáé ìå Üë-
ëá ÷áñáêôçñéóôéêÜ Þ âéï÷çìéêÝò éäéüôçôåò ôùí áðï-
ìïíþóåùí. Ç ðñïóöõãÞ óå ðåñéóóüôåñåò ôçò ìéáò
ôá÷åßáò ìåèüäïõ èá ìðïñïýóå åðßóçò íá áõîÞóåé ôçí
áêñßâåéá ôùí áðïôåëåóìÜôùí.

Summary

Evaluation of five commercial tests for the rapid identification of

Staphylococcus aureus

C. Tsiveriotis1,2, K.S Hatzigeorgiou2, K. Zouridaki1, S. Konstantoulaki1, L. Zerva2, O. Paniara1,

A. Argyropoulou1
1Department of Microbiology, General Hospital "Evangelismos", Athens, Greece
2Clinical
Microbiology Laboratory, General University Hospital "Attikon", Medical School, University of
Athens, Chaidari, Greece

The commercially available latex agglutination assays that detect the bound coagulase are currently
used in the routine practice for the rapid identification of S. aureus. The aim of the present report was
to evaluate the performance of second and third generation products, using a battery of different cli- 213
nical staphylococcal isolates. A total 113 non-repetitive staphylococcal isolates, specifically 47 S. au-
reus and 66 CNS (comprised of S. epiderimidis, S. hominis, S. lugdunensis, S. haemolyticus, S.
simulans, S. cohnii and S. sciuri species) were included in the study. The identification to the species
level was performed by tuf gene PCR followed by RFLP analysis and/or 16S rRNA gene sequencing.
The commercial kits Staphaurex Plus (Remel, Europe Ltd, Kent UK), Staphaurex (Remel, Europe Ltd,
Kent UK), BBL Staphyloslide (Becton Dickinson and Company, Sparks, USA), Staphytect Plus (Oxoid
Ltd, Basingstoke, Hants, UK) êáé Slidex Staph Plus (bioMerieux S.A., Marcy l' Etoile, France) were ap-
plied in all isolates following the manufacturer's instructions. Sensitivity and specificity rates respe-
ctively for each product were estimated as follows: 97.8% and 100% for Staphaurex, 100% and 93.9%
for BBL Staphyloslide, 100% and 80.3% for Staphytect Plus, 100% and 97.0% for Slidex Staph Plus
and 100% and 87.9% for Staphaurex Plus. Non-specific agglutination reactions, which were classifi-
ed as negative results after repeated testing, were observed with Staphytect Plus, BBL Staphylosli-
de and Staphaurex Plus. Among CNS, S. lugdunensis and S. epidermidis species were the only
species that produced positive results by four out of the five commercial kits under evaluation. In
conclusion, tube coagulase assay remains the "gold standard" for the detection of S. aureus, while
slide coagulase testing seems a reasonable alternative. All latex agglutination products assessed in
the present study exhibited excellent sensitivity results, while Staphaurex and Slidex Staph Plus had
higher specificity. However, the use of any of these products on a routine basis necessitates experi-
ence and careful evaluation of either positive or negative results.

Key words
Staphylococcus, coagulase, rapid tests.

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Ê. ÔÓÉÂÅÑÉÙÔÇÓ, Ê.Ó. ×ÁÔÆÇÃÅÙÑÃÉÏÕ, Ê. ÆÏÕÑÉÄÁÊÇ ÊÁÉ ÓÕÍ.
Âéâëéïãñáößá
1. Luijendijk A, van Belkum A, Verbrugh H, Kluytmans J. Compari-
son of five tests for identification of Staphylococcus aureus from
clinical samples. J Clin Microbiol 1996; 34: 2267-2269.
2. Overview of bacterial identification methods and strategies. In:
Bailey and Scott's. Diagnostic Microbiology. Mosby Elsevier 12th
edition, 2007: 216-247.
3. Van Griethuysen A, Bes M, Etienne J, Zbinden R, Kluytmans J.
International multicenter evaluation of latex agglutination tests for
identification of Staphylococcus aureus. J Clin Microbiol, 2001; 39:
86-89.
4. Kontos F, Petinaki E, Spiliopoulou I, Maniati M, Maniatis AN.
Evaluation of a novel method based on PCR restriction fragment
length polymorphism analysis of the tuf gene for the identifica-
tion of Staphylococcus species. J Microbiol Methods 2003; 55: 465-
469.
5. Hiraishi A. Direct automated sequencing of 16S rDNA amplified
bypolymerase chain reaction from bacterial cultures without DNA
purification. Lett Appl Microbiol 1992; 15: 210-213.
6. Wilkerson M, McAllister S, Miller JM, Heiter BJ, Bourbeau PP.
Comparison of five agglutination tests for identification of Staphy-
lococcus aureus. J Clin Microbiol 1997; 35: 148-151.
7. Piper J, Hadfield T, McCleskey F, Evans M, Friedstrom S,
Lauderdale P et al. Efficacies of rapid agglutination tests for ide-
ntification of methicillin-resistant staphylococcal strains as Staphy-
lococcus aureus. J Clin Microbiol 1988; 26: 1907-1909.
8. Ruane PJ, Morgan MA, Citron DM, Mulligan ME. Failure of ra-
pid agglutination methods to detect oxacillin-resistant Staphylo-
coccus aureus. J Clin Microbiol 1986; 24: 490-492.
9. Wanger AR, Morris SL, Ericsson C, Singh KV, LaRocco MT. La-
tex agglutination-negative methicillin-resistant Staphylococcus au-
214
VOL. 54 • ISSUE 4, July - August 2009
reus recovered from neonates: epidemiologic features and compa-
rison of typing methods. J Clin Microbiol 1992; 30: 2583-2588.
10. Fournier JM, Bouvet A, Mathieu D, Nato F, Boutonnier A, Ger-
bal R et al. New latex reagent using monoclonal antibodies to cap-
sular polysaccharide for reliable identification of both oxacillin-
susceptible and oxacillin-resistant Staphylococcus aureus. J Clin Mi-
crobiol 1993; 31: 1342-1344.
11. Fournier JM, Boutonnier A, Bouvet A. Staphylococcus aureus s-
trains which are not identified by rapid agglutination methods are
of capsular serotype 5. J Clin Microbiol 1989, 27: 1372-1374.
12. Personne P, Bes M, Lina G, Vandenesch F, Brun Y, Etienne J.
Comparative performances of six agglutination kits assessed by us-
ing typical and atypical strains of Staphylococcus aureus. J Clin Mi-
crobiol 1997; 35: 1138-1140.
13. Bannerman TL and Peacock SJ Staphylococcus, Micrococcus, and
other catalase-positive cocci. In: Ìurray P. et al (eds). Manual of Cli-
nical Microbiology Vol I, Washington DC, ASM press, 2007: 390-411.
14. Mitchell J, Tristan A, Foster TJ. Characterization of the fibrino-
gen-binding surface protein Fbl of Staphylococcus lugdunensis. Mi-
crobiology 2004; 150: 3831-3841.
15. Blake JE, Metcalfe MA. A Shared noncapsular antigen is respon-
sible for false-positive reactions by Staphylococcus epidermidis in
commercial agglutination tests for Staphylococcus aureus. J Clin
Microbiol 2001; 39: 544-550.
16. Nilsson M, Frykberg L, Flock JI, Pei L, Lindberg M, Guss B. A fi-
brinogen-binding protein of Staphylococcus epidermidis. Infect Im-
mun 1998; 66: 2666-2673.
17. Maxim P, Mathews H, Mengoli H. Single-tube agglutination test
for the detection of staphylococcal protein A. J Clin Microbiol
1976; 4: 418-422.
7-ereunitiki.qxd 14/10/2009 2:42 Page 215

ÅñåõíçôéêÞ Åñãáóßá

ÃáóôñåíôåñéêÝò ëïéìþîåéò áðü rotavirus, adenovirus, norovirus êáé

astrovirus óå íïóçëåõüìåíïõò áóèåíåßò ãåíéêïý íïóïêïìåßïõ

Ì. ÓáââÜëá1, É. ÄáíéÞë1, É. Ìðåñìðåñßäïõ1, Á. Êïõôóéìðßñç1, Á. Óôáìðïëßäç1, Ì. Ðáðá÷ñéóôïäïýëïõ1,

Í. ÓðáíÜêçò2, Ä. Ðåôñïðïýëïõ1, A. ÔóáêñÞò2
1Ìéêñïâéïëïãéêü ÅñãáóôÞñéï, Ã. Í. Íßêáéáò ÐåéñáéÜ “¢ãéïò ÐáíôåëåÞìùí”, ÐåéñáéÜò
2ÅñãáóôÞñéï Ìéêñïâéïëïãßáò, ÉáôñéêÞ Ó÷ïëÞ, ÐáíåðéóôÞìéï Áèçíþí, ÁèÞíá

Ðåñßëçøç
215

Óôçí ðáñïýóá ìåëÝôç åîåôÜóèçêå ç óõ÷íüôçôá êáé ç åðï÷éêÞ êáôáíïìÞ ôùí éïãåíþí ãáóôñåíôåñé-
êþí ëïéìþîåùí óå áóèåíåßò ìå äéÜññïéá ðïõ íïóçëåýôçêáí óôï Ã.Í.Íßêáéáò ÐåéñáéÜ "Áã. Ðáíôåëå-
Þìùí". ÊáôÜ ôç äéÜñêåéá åíüò Ýôïõò, åîåôÜóôçêáí 201 äåßãìáôá êïðñÜíùí, áðü éóÜñéèìïõò áóèåíåßò
ìå óõìðôþìáôá ãáóôñåíôåñßôéäáò (165 áðü ôçí ðáéäéáôñéêÞ êëéíéêÞ, 21 áðü ôç ÌïíÜäá Ðñïþñùí
êáé 15 áðü åíÞëéêåò áóèåíåßò) ãéá ôçí áíáæÞôçóç áíôéãüíùí rotavirus, adenovirus, astrovirus êáé no-
rovirus. Ç áíß÷íåõóç ôùí áíôéãüíùí ôùí éþí rotavirus, adenovirus êáé astrovirus Ýãéíå ìå ôç ìÝèïäï
ôçò áíïóï÷ñùìáôïãñáöéáò, åíþ ãéá ôçí áíß÷íåõóç ôïõ áíôéãüíïõ norovirus ÷ñçóéìïðïéÞèçêå ç
áíïóïåíæõìéêÞ ìÝèïäïò. Ãéá ôçí åðéâåâáßùóç ôçò ëïßìùîçò áðü norovirus ÷ñçóéìïðïéÞèçêå ç rever-
se transcriptase-Polymerase Chain Reaction (RT-PCR). ÓõíïëéêÜ áíé÷íåýèçêáí 51 éúêÜ áíôéãüíá áðü
48/201 (24%) áóèåíåßò, êõñßùò ôçò ðáéäéáôñéêÞò êëéíéêÞò. Ç óõ÷íüôçôá áíß÷íåõóçò ôùí rotavirus,
adenovirus, norovirus êáé astrovirus Þôáí 14,9% (30/201), 7% (14/201), 3% (6/201) êáé 0.5% (1/201),
áíôßóôïé÷á. Éäéáßôåñï åíäéáöÝñïí ðáñïõóéÜæïõí ïé ðåñéðôþóåéò üðïõ áíé÷íåýèçêå norovirus, êá-
èþò áðïìïíþèçêå áðü ôñåéò áóèåíåßò êáôÜ ôçí äéÜñêåéá åðéäçìßáò ôïí ÄåêÝìâñéï ôïõ 2007: ìßá ðå-
ñßðôùóç áóèåíïýò áðü êñïõáæéåñüðëïéï êáé äýï íåïãíÜ ôçò ÌïíÜäáò Ðñïþñùí. Óå ôñåßò áóèåíåßò
ðáñáôçñÞèçêå ìåéêôÞ ëïßìùîç áðü äýï éïýò: ìßá ðåñßðôùóç áðü norovirus êáé astrovirus, êáé äýï
ðåñéðôþóåéò áðü rotavirus êáé adenovirus. Ïé ðåñéóóüôåñåò ðåñéðôþóåéò éïãåíþí ãáóôñåíôåñéôßäùí
ðáñáôçñÞèçêáí ôçí Üíïéîç 37,5% (18/48) êáé ôï êáëïêáßñé 27,1% (13/48) êáé ïöåßëïíôáí êõñßùò óå
rotavirus. Ïé ëïéìþîåéò áðü norovirus ðáñáôçñÞèçêáí ôï ÷åéìþíá êáé ôéò áñ÷Ýò ôïõ öèéíïðþñïõ. Óõ-
ìðåñáóìáôéêÜ, ïé rotaviruses, áêïëïõèïýìåíïé áðü ôïõò adenoviruses, áðïôåëïýí ôéò êýñéåò áéôß-
åò éïãåíþí ãáóôñåíôåñéêþí ëïéìþîåùí óå áóèåíåßò ðáéäéáôñéêþí êëéíéêþí. Ç ôá÷åßá äéÜãíùóç ôùí

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
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Ì. ÓÁÂÂÁËÁ, É. ÄÁÍÉÇË, É. ÌÐÅÑÌÐÅÑÉÄÏÕ ÊÁÉ ÓÕÍ.
éïãåíþí ãáóôñåíôåñéêþí ëïéìþîåùí åðéôñÝðåé ôçí áðïöõãÞ Üóêïðçò áíôéìéêñïâéáêÞò áãùãÞò êáé
ôçí ãñÞãïñç áðïìüíùóç ôïõ ìïëõóìáôéêïý áóèåíïýò ãéá ôçí áðïöõãÞ åðéäçìéþí.
ËÝîåéò êëåéäéÜ
Ãáóôñåíôåñßôéäá, éïß,
äéÜññïéá.
ÅéóáãùãÞ
Åßíáé ãíùóôü üôé ïé ëïéìþîåéò ôïõ ãáóôñåíôåñéêïý
óõóôÞìáôïò áðïôåëïýí Ýíá áðü ôá ðéï óõ÷íÜ íïóÞ-
ìáôá ðïõ ðñïóâÜëëïõí ôïí Üíèñùðï. Õðïëïãßæåôáé
üôé ðåñéóóüôåñåò áðü 700 åêáôïììýñéá ðåñéðôþ-
óåéò ïîåßáò äéáññïúêÞò íüóïõ åìöáíßæïíôáé êÜèå
÷ñüíï ðáãêïóìßùò ìüíï óå ðáéäéÜ çëéêßáò <5
åôþí.1 Óôéò ÇíùìÝíåò Ðïëéôåßåò ôçò ÁìåñéêÞò ç
ïîåßá ãáóôñåíôåñßôéäá áðïôåëåß ôï äåýôåñï áßôéï
ïîåßáò íüóïõ áìÝóùò ìåôÜ ôçí ïîåßá éïãåíÞ áíá-
ðíåõóôéêÞ íüóï.2
Ç ïîåßá ãáóôñåíôåñßôéäá êëéíéêÜ åìöáíßæåôáé óõ-
íÞèùò ìå Þðéá äéÜññïéá, åíþ ïé ðåñéóóüôåñï óïâá-
ñÝò ìïñöÝò ôçò íüóïõ ìðïñåß íá åìöáíßóïõí
óõìðôþìáôá áðü ôï áíþôåñï ãáóôñåíôåñéêü, üðùò
íáõôßá êáé åìÝôïõò, ìÝ÷ñé êáé óïâáñÞ äéÜññïéá ðïõ
ïäçãåß óå áöõäÜôùóç êáé èÜíáôï. Ç åôÞóéá èíçôüôç-
216 ôá ðïõ ó÷åôßæåôáé ìå ôç íüóï Ý÷åé åêôéìçèåß üôé åßíáé
3,5-5 åêáôïììýñéá, ìå ôçí ðëåéïíüôçôá ôùí èáíÜôùí
íá åìöáíßæåôáé óå áíáðôõóóüìåíåò ÷þñåò.1,2
Ç ïîåßá ëïßìùîç ôïõ ãáóôñåíôåñéêïý ðñïêáëåßôáé
áðü äéÜöïñïõò ðáñÜãïíôåò, üðùò âáêôÞñéá, éïýò
êáé ðáñÜóéôá. ÌÝ÷ñé ðñüóöáôá, ðïëëÝò ðåñéðôþóåéò
áðïäßäïíôáí óå éïýò ëüãù ôçò áðïôõ÷ßáò íá ôáõôï-
ðïéçèïýí âáêôçñéáêÜ Þ ðáñáóéôéêÜ ðáèïãüíá. Ìü-
ëéò ôï 1972 Ýíáò éüò (Norwalk éüò) ôáõôïðïéÞèçêå ùò
áßôéï ïîåßáò ãáóôñåíôåñßôéäáò.3 Áðü ôüôå, ï áñéèìüò
ôùí éúêþí ðáñáãüíôùí ðïõ ó÷åôßæïíôáé ìå ôç íüóï
Ý÷åé ðñïïäåõôéêÜ áõîçèåß. Óôéò ÇíùìÝíåò Ðïëéôåßåò
ôçò ÁìåñéêÞò áíáöÝñåôáé üôé ïé éïß ðñïêáëïýí ôï
80% ôùí ðåñéðôþóåùí ïîåßáò ëïßìùîçò ôïõ ãáóôñå-
íôåñéêïý.2
ÄéÜöïñïé éïß Ý÷ïõí áíåõñåèåß óôá êüðñáíá áôü-
ìùí ìå ãáóôñåíôåñßôéäá.3 Ïé éïß ðïõ Ý÷ïõí åðéâåâáéù-
èåß ùò áéôéïëïãéêïß ðáñÜãïíôåò ôçò ïîåßáò
ãáóôñåíôåñßôéäáò åßíáé: rotavirus (ïéêïãÝíåéá Reoviri-
dae), adenovirus (ïéêïãÝíåéá Adenoviridae), norovirus
(ïéêïãÝíåéá Caliciviridae), astrovirus (ïéêïãÝíåéá
Astroviridae) êáé Üëëïé éïß (êëáóéêïß calicoviruses, co-
ronavirus, torovirus).
Ïé éïß áõôïß Ý÷ïõí Þäç áíáãíùñéóèåß áðü ôá ôÝëç
VOL. 54 • ISSUE 4, July - August 2009
Yðåýèõíïò áëëçëïãñáößáò
ÉùÜííçò ÄáíéÞë,
Ìéêñïâéïëïãéêü ÅñãáóôÞñéï
Ã.Í.Í.Ð. "¢ãéïò ÐáíôåëåÞìùí",
Äçì. Ìáíôïýâáëïõ 3,
18454, Íßêáéá
e-mail: idaniil@med.uoa.gr
ôçò äåêáåôßáò ôïõ '70 ìå ôç âïÞèåéá ôçò çëåêôñïíéêÞò
ìéêñïóêüðéóçò, åíþ ç ìåëÝôç ôùí rotavirus, ade-
novirus êáé astrovirus Ý÷åé äéåõêïëõíèåß óå ìåãÜëï
âáèìü áðü ôçí éêáíüôçôÜ ôïõò íá áíáðáñÜãïíôáé óå
êõôôáñïêáëëéÝñãåéåò. Ç äõíáôüôçôá áõôÞ Ý÷åé åðéôñÝ-
øåé ôçí ðáñáãùãÞ áíôéäñáóôçñßùí ðïõ ÷ñçóéìï-
ðïéïýíôáé ãéá äéáãíùóôéêÝò åîåôÜóåéò, ôçí êáëýôåñç
êáôáíüçóç ôùí ðáñáãüíôùí ðïõ ó÷åôßæïíôáé ìå ôçí
áíïóéáêÞ áðÜíôçóç óôç ëïßìùîç êáé ôçí áðïóáöÞíé-
óç ôïõ êýêëïõ æùÞò êÜèå éïý. Ïé calicoviruses äåí
áíáðôýóóïíôáé óå êõôôáñïêáëëéÝñãåéåò êáé ïé ãíþ-
óåéò ìáò ãéá áõôïýò ôïõò éïýò óôçñßæïíôáé êáôÜ êýñéï
ëüãï óôç ÷ñÞóç ìïñéáêþí ôå÷íéêþí.4
Ðáñ' üôé ïé rotavirus, adenovirus, norovirus êáé as-
trovirus Ý÷ïõí áíáãíùñéóôåß ùò áßôéá ôùí ëïéìþîåùí
ôïõ ãáóôñåíôåñéêïý, åí ôïýôïéò ëßãá åßíáé ãíùóôÜ ó÷å-
ôéêÜ ìå ôç óõ÷íüôçôá êáé ôçí åðï÷éêÞ êáôáíïìÞ áõôþí
ôùí éïãåíþí ãáóôñåíôåñéêþí ëïéìþîåùí óå íïóçëåõü-
ìåíïõò ìå äéÜññïéá áóèåíåßò. Ôï ãåãïíüò áõôü áðï-
ôÝëåóå êáé ôçí áöïñìÞ ãéá ôçí ðñáãìáôïðïßçóç ôçò
ðáñïýóáò ìåëÝôçò.
Õëéêü êáé ìÝèïäïé
Äåßãìáôá êïðñÜíùí áðü 201 áóèåíåßò ðïõ íïóçëåý-
èçêáí ìå óõìðôþìáôá ãáóôñåíôåñßôéäáò óôï Ãåíéêü
Íïóïêïìåßï Íßêáéáò ÐåéñáéÜ. "¢ãéïò ÐáíôåëåÞìùí",
åóôÜëçóáí óôï ïñïëïãéêü ôìÞìá ôïõ Ìéêñïâéïëïãé-
êïý Åñãáóôçñßïõ ãéá ôçí áíáæÞôçóç éïãåíþí áéôßùí.
Ç ðåñßïäïò åîÝôáóçò ôùí äåéãìÜôùí Þôáí Ýíá Ýôïò
(ÍïÝìâñéïò 2007 - ÍïÝìâñéïò 2008).
Áðü ôá äåßãìáôá ðïõ åîåôÜóôçêáí, 165 ðñïÝñ÷ï-
íôáí áðü áóèåíåßò ôçò ðáéäéáôñéêÞò êëéíéêÞò, 21 áðü
íåïãíÜ ôçò ÌïíÜäá Ðñïþñùí êáé 15 áðü åíÞëéêåò
áóèåíåßò.
Ôá äåßãìáôá åîåôÜóôçêáí ãéá ôçí áíáæÞôçóç áíôé-
ãüíùí rotavirus, adenovirus, norovirus êáé astrovirus.
Ç ìÝèïäïò ðïõ ÷ñçóéìïðïéÞèçêå ãéá ôçí áíß÷íåõóç
ôùí áíôéãüíùí ôùí éþí rotavirus, adenovirus êáé astro-
virus Þôáí ç áíïóï÷ñùìáôïãñáößá óå ìåìâñÜíç (Ro-
tavirus êáé Adenovirus, VIKIA®-bioMerieux, Marcy
7-ereunitiki.qxd 14/10/2009 2:42 Page 217

?????? ?????? ???????? ???? ÁÉÔÉÁ ÉÏÃÅÍÙÍ

??????? ËÏÉÌÙÎÅÙÍ
???????????? ???ÔÏÕ ÃÁÓÔÑÅÍÔÅÑÉÊÏÕ
Blastocystis sp.

l'Etoile, France êáé H & R Astrovirus, Vegal Farmaceuti- ÊáôáíïìÞ ôùí áóèåíþí ìå éïãåíÞ ãáóôñåíôåñßôéäá
ca, Spain). Ãéá ôçí áíß÷íåõóç ôïõ áíôéãüíïõ ôïõ no- Ðßíáêáò 1 ìå âÜóç ôçí áéôßá êáé ôï åßäïò ôçò ëïßìùîçò.
rovirus ÷ñçóéìïðïéÞèçêå áíïóïåíæõìéêÞ ìÝèïäïò
(Ridascreen® r-biopharm, Germany). Áóèåíåßò Ëïéìþîåéò
Ãéá ôçí áíßí÷åõóç ôïõ ãåíåôéêïý õëéêïý ôïõ éïý Rotavirus 28
ðñáãìáôïðïéÞèçêå reverse transcriptase - Polymera- Adenovirus 12 45 áðëÝò
se Chain Reaction (RT-PCR). Ç RT-PCR ãéá ôçí áíß- Norovirus 5
÷íåõóç ôïõ norovirus, ðñáãìáôïðïéÞèçêå óôï Astrovirus –
ÅñãáóôÞñéï Ìéêñïâéïëïãßáò ôçò ÉáôñéêÞò Ó÷ïëÞò ôïõ Rotavirus+Adenovirus 2 3 ìåéêôÝò
Ðáíåðéóôçìßïõ Áèçíþí óýìöùíá ìå ôï ðñùôüêïëëï Norovirus+Astrovirus 1
ôùí Jiang êáé óõí.,5 êáé åðéâåâáßùóå ôï áðïôÝëåóìá Óýíïëï 48 48
ôçò áíïóïåíæõìéêÞò ìåèüäïõ.

ôï ÄåêÝìâñéï 2007 ðïõ åêäçëþèçêå óå ðáèïëïãéêÞ

ÁðïôåëÝóìáôá
Áðü ôïõò 201 áóèåíåßò ôùí ïðïßùí ôá äåßãìáôá êï-
ðñÜíùí åîåôÜóèçêáí ãéá éúêÜ áíôéãüíá, 48 áóèåíåßò
(24%) Þôáí èåôéêïß. Ïé ðåñéóóüôåñïé (40) Þôáí áóèå-
íåßò ôçò ðáéäéáôñéêÞò êëéíéêÞò, ðÝíôå Þôáí åíÞëéêåò
êáé ôñåéò Þôáí ðñüùñá íåïãíÜ. Ç óõ÷íüôçôá áíß÷íåõ-
óçò ôùí rotavirus, adenovirus, norovirus êáé astrovirus
Þôáí 14,9% (30/201), 7% (14/201), 3% (6/201) êáé 0.5%
(1/201), áíôßóôïé÷á.
Óå 45 áóèåíåßò áíé÷íåýèçêå ìüíï Ýíá éúêü áíôéãü-
íï, åíþ óå 3 áóèåíåßò äéáðéóôþèçêå ìåéêôÞ ëïßìùîç
áðü äýï éïýò: óôç ìßá ðåñßðôùóç ç ëïßìùîç Þôáí áðü
norovirus êáé astrovirus, êáé óôéò Üëëåò äýï ðåñéðôþ-
óåéò áðü rotavirus êáé adenovirus (Ðßíáêáò 1). Ïé êáë-
ëéÝñãåéåò ãéá âáêôÞñéá üëùí ôùí äåéãìÜôùí Þôáí
áñíçôéêÝò.
Rotavirus áíé÷íåýèçêå áðïêëåéóôéêÜ óå ðáéäéÜ. No-
rovirus áðïìïíþèçêå óå ðÝíôå áóèåíåßò. Ïé ôñåéò
áóèåíåßò Þôáí åíÞëéêåò êáôÜ ôç äéÜñêåéá åðéäçìßáò
êëéíéêÞ. Ìßá ðåñßðôùóç áöïñïýóå áóèåíÞ ðïõ äéáêï-
ìßóèçêå ãéá íïóçëåßá áðü êñïõáæéåñüðëïéï, ìåôÜ áðü
ëéðïèõìéêü åðåéóüäéï, ìå ðõñåôü êáé äéÜññïéá. Äýï
ðåñéóôáôéêÜ áöïñïýóáí äýï íåïãíÜ ôçò ÌïíÜäáò
Ðñïþñùí, üðïõ ç ðçãÞ ôçò ëïßìùîçò åéêÜæåôáé üôé
Þôáí ç ìçôÝñá åíüò íåïãíïý, ðïõ êáôÜ ôçí ðáñáìï-
íÞ ôçò óôç ÌïíÜäá ãéá ôç öñïíôßäá ôïõ åß÷å åìöáíß-
óåé åðßóçò äéáññïúêü óýíäñïìï.
Ç åðï÷éêÞ êáôáíïìÞ ôùí êñïõóìÜôùí éïãåíïýò
ãáóôñåíôåñßôéäáò ðïõ åêäçëþèçêáí óôïõò áíùôÝñù
áóèåíåßò öáßíåôáé óôçí åéêüíá 1. ¼ðùò ðáñáôçñïý-
ìå, ç ðëåéïíüôçôá ôùí ðåñéóôáôéêþí éïãåíïýò ãá-
óôñåíôåñßôéäáò åìöáíßóèçêå ôçí Üíïéîç (37,5%,
18/48) êáé ôï êáëïêáßñé (27,1%, 13/48) êáé ï êýñéïò
áéôéïëïãéêüò ðáñÜãùí Þôáí ï rotavirus. Ïé ãáóôñå-
íôåñßôéäåò ðïõ ðñïêëÞèçêáí áðü adenovirus ðáñá-
ôçñÞèçêáí ôï êáëïêáßñé êáé ôï öèéíüðùñï, åíþ
áõôÝò ðïõ ïöåßëïíôáí óå norovirus óôéò áñ÷Ýò ôïõ
öèéíïðþñïõ êáé ôï ÷åéìþíá. 217

Åéêüíá 1. Åðï÷éêÞ êáôáíïìÞ ôùí éïãåíþí ãáóôñåíôåñßôéäùí.

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Ì. ÓÁÂÂÁËÁ, É. ÄÁÍÉÇË, É. ÌÐÅÑÌÐÅÑÉÄÏÕ ÊÁÉ ÓÕÍ.
ÓõæÞôçóç
Ïé ëïéìþîåéò ôïõ ãáóôñåíôåñéêïý áðïôåëïýí óçìá-
íôéêü áßôéï íïóçñüôçôáò êáé èíçóéìüôçôáò ìå ðáãêü-
óìéá êáôáíïìÞ êáé ðñïêáëïýíôáé óå Ýíá ìåãÜëï
ðïóïóôü áðü éúêÜ ðáèïãüíá.6 Ïé rotavirus, ade-
novirus, norovirus, astrovirus, êëáóóéêïß calicoviruses,
coronavirus êáé torovirus Ý÷åé áðïäåé÷èåß üôé ðñïêá-
ëïýí éïãåíÞ ãáóôñåíôåñßôéäá.3
Ç åêäÞëùóç åðéäçìßáò áðü ôïõò éïýò áõôïýò
áðïôåëåß öáéíüìåíï ðïõ ôá ôåëåõôáßá ÷ñüíéá Ý÷åé
ëÜâåé óïâáñÝò äéáóôÜóåéò, ìå ðñüóöáôï ðáñÜäåéã-
ìá ôçí åìöÜíéóç åðéäçìéêþí êñïõóìÜôùí (ðåñßðïõ
2 åêáôïììýñéá êñïýóìáôá) áðü norovirus óôï Çíù-
ìÝíï Âáóßëåéï ôï ÷åéìþíá ôïõ 2007-2008. Ç åðéäç-
ìßá áõôÞ ðñïêÜëåóå óçìáíôéêü êïéíùíéêü êáé
ïéêïíïìéêü êüóôïò êáé Ýêáíå åðéôáêôéêÞ ôçí áíÜãêç
ãéá áíáæÞôçóç ãñÞãïñùí ìåèüäùí áíß÷íåõóçò ôïõ
éïý êáé ôçí Üìåóç ëÞøç êáôÜëëçëùí ìÝôñùí ðñüëç-
øçò.7
Ç ìåëÝôç ôçò óõ÷íüôçôáò êáé ôçò åðï÷éêÞò êáôá-
íïìÞò ôùí ëïéìþîåùí ôïõ ãáóôñåíôåñéêïý áðü ro-
tavirus, adenovirus, norovirus êáé astrovirus óå
íïóçëåõüìåíïõò áóèåíåßò ìå äéÜññïéá áðïôÝëåóå
ôï áíôéêåßìåíï ôçò ðáñïýóáò åñãáóßáò. Óôçí äéÜñ-
êåéá åíüò Ýôïõò ìåëåôÞèçêáí ôá äåßãìáôá êïðñÜíùí
ôùí áóèåíþí, ðïõ åóôÜëçóáí óôï ïñïëïãéêü åñãá-
óôÞñéï ãéá áíß÷íåõóç éúêþí áíôéãüíùí. Ôá ðåñéóóüôå-
ñá áöïñïýóáí ðáéäéáôñéêïýò áóèåíåßò, ãåãïíüò
ðïõ óõìâáäßæåé ìå ôç óõ÷íüôåñç åíôüðéóç áõôþí
ôùí ëïéìþîåùí óôá ðáéäéÜ.8 Ïé rotavirus êáé ade-
novirus Þôáí ïé óõ÷íüôåñá áðïìïíùèÝíôåò éïß óôïõò
ðáéäéáôñéêïýò áóèåíåßò, êÜôé ðïõ áíáìåíüôáí, êá-
218
èþò áõôïß ïé éïß áðïôåëïýí ôá êýñéá ðáèïãüíá óôá
ðáéäéÜ.9,10
Óôçí ÅëëÜäá ç åðéäçìéïëïãéêÞ äéåñåýíçóç ôçò éï-
ãåíïýò ãáóôñåíôåñßôéäáò åßíáé ðåñéïñéóìÝíç êáé Ý÷åé
åðéêåíôñùèåß áðïêëåéóôéêÜ óôïí ðáéäéáôñéêü ðëçèõ-
óìü. Ùóôüóï, ôá ìÝ÷ñé óÞìåñá äåäïìÝíá äåí äéáöÝ-
ñïõí óçìáíôéêÜ ìå ôá áðïôåëÝóìáôá ôçò ðáñïýóçò
ìåëÝôçò, üóïí áöïñÜ óôïõò ðáéäéáôñéêïýò áóèåíåßò.
Óå ìåëÝôç ðïõ ðñáãìáôïðïéÞèçêå êáôÜ ôç äéÜñêåéá
6 åôþí êáé áöïñïýóå ìüíï ðáéäéÜ ðïõ íïóçëåýôçêáí
ìå ïîåßá ãáóôñåíôåñßôéäá, óôï 31% ôùí ðáéäéþí áíé-
÷íåýèçêå éúêüò ðáñÜãùí, ìå êýñéï áßôéï ôçò éïãåíïýò
ãáóôñåíôåñßôéäáò ôïí rotavirus.11
Ãéá ôçí áíß÷íåõóÞ ôïõ éïý áñ÷éêÜ ÷ñçóéìïðïéÞ-
èçêå ç áíïóïåíæõìéêÞ ìÝèïäïò. Ôï áðïôÝëåóìá åðé-
âåâáéþèçêå ìå ôçí áíß÷íåõóç ôïõ ãåíåôéêïý õëéêïý
ôïõ norovirus ìå ôç ìÝèïäï RT-PCR. Ïé ôá÷åßåò ïñï-
ëïãéêÝò ìÝèïäïé, üðùò ç áíïóï÷ñùìáôïãñáößá êáé
ç áíïóïåíæõìéêÞ ìÝèïäïò, ïé ïðïßåò ÷ñçóéìïðïéïý-
íôáé ãéá ôçí áíß÷íåõóç ôùí éúêþí ðáñáãüíôùí ðïõ
ðñïêáëïýí ãáóôñåíôåñßôéäá, åðéôñÝðïõí ôçí Ýãêáé-
ñç äéÜãíùóç ôùí êñïõóìÜôùí êáé åßíáé êáôÜëëçëåò
ãéá ìéêñÜ åñãáóôÞñéá.1 ÁõôÞ ç äõíáôüôçôá ïäçãåß
VOL. 54 • ISSUE 4, July - August 2009
óôçí Üìåóç ëÞøç ôùí áðáñáßôçôùí ìÝôñùí, üðùò ç
áðïìüíùóç ôïõ áóèåíïýò, ãéá íá áðïöåõ÷èåß ç ìå-
ôÜäïóç ôïõ éïý êáé íá ðñïëçöèåß ç åêäÞëùóç åðéäç-
ìßáò.
Ï norovirus áðïâÜëëåôáé óôá êüðñáíá óå ìéêñÝò
óõãêåíôñþóåéò êáé ãé'áõôü ôï ëüãï ç RT-PCR áðïôå-
ëåß ìÝèïäï åêëïãÞò ãéá ôçí áíß÷íåõóÞ ôïõ, êáèþò åíé-
ó÷ýåé ôá ìéêñÜ ðïóÜ RNA ôïõ éïý ðïõ õðÜñ÷ïõí óôï
ýðïðôï äåßãìá.12,13 Ç åõáéóèçóßá êáé ç åéäéêüôçôá ôçò
RT-PCR Ý÷åé åêôéìçèåß üôé åßíáé 100% êáé 84% áíôß-
óôïé÷á. Ç RT-PCR åßíáé ìÝèïäïò ðéï åõáßóèçôç áðü
ôçí áíïóïåíæõìéêÞ (åõáéóèçóßá 45% êáé åéäéêüôçôá
97%) êáé ðéï åéäéêÞ áðü ôçí áíïóï÷ñùìáôïãñáößá
(åõáéóèçóßá 100% êáé åéäéêüôçôá 24%), üóïí áöïñÜ
óôçí áíß÷íåõóç ôùí éþí ðïõ ðñïêáëïýí ãáóôñåíôå-
ñßôéäá.14,15
Éäéáßôåñï åíäéáöÝñïí ðáñïõóéÜæïõí ôñåéò ðåñé-
ðôþóåéò ãáóôñåíôåñßôéäáò áðü norovirus Þ norovirus
êáé astrovirus. Áîßæåé íá óçìåéùèåß üôé ç áíß÷íåõóç
ôïõ norovirus óå êñïýóìá ïîåßáò ãáóôñåíôåñßôéäáò
ðïõ åêäçëþèçêå óå êñïõáæéåñüðëïéï åßíáé óýìöùíç
ìå áíáöïñÝò ðáñüìïéùí êñïõóìÜôùí áðü áõôü ôïí
éü óå êñïõáæéåñüðëïéá. Ôïí Éïýíéï ôïõ 2006 ðáñáôç-
ñÞèçêå îáöíéêÞ áýîçóç ôùí êñïõóìÜôùí áðü no-
rovirus óå êñïõáæéåñüðëïéá (43 êñïýóìáôá
åìöáíßóôçêáí óå 13 êñïõáæéåñüðëïéá).16 Ôçí ßäéá
åðï÷Þ, ìßá ðåñßðôùóç åðéäçìßáò áðü norovirus áíá-
öÝñèçêå óå ðïôáìüðëïéï, ôï ïðïßï áíÞêå óå éäéïêôÞ-
ôç ðïõ åß÷å Üëëá äýï ðëïßá ìå ðáñüìïéá êñïýóìáôá.
Ôï ãåãïíüò áõôü êáôÝäåéîå üôé õðÞñîå êïéíÞ ðçãÞ
ôçò ëïßìùîçò.17 ÐñÜãìáôé ï éüò áõôüò åõèýíåôáé ãéá
ôçí åêäÞëùóç åðéäçìéþí óå éäñýìáôá, åóôéáôüñéá êáé
êñïõáæéåñüðëïéá, üðùò åðßóçò êáé ãéá ðåñéóóüôåñï
ôïõ 95% ôùí åðéäçìéþí éïãåíïýò ãáóôñåíôåñßôéäáò
óôçí Åõñþðç. Ç äéåñåýíçóç ôùí åðéäçìéþí áðü no-
rovirus êáôáäåéêíýåé óõíÞèùò ìåôáöïñÜ ôïõ éïý áðü
Üôïìï óå Üôïìï.
Ôá ðåñéóóüôåñá áðü ôá åðåéóüäéá ãáóôñåíôåñßôé-
äáò áðü rotavirus åìöáíßóôçêáí ôçí Üíïéîç êáé ôï êá-
ëïêáßñé, åíþ ïé ëïéìþîåéò áðü norovirus
ðáñáôçñÞèçêáí ôï ÷åéìþíá êáé ôéò áñ÷Ýò ôïõ öèéíï-
ðþñïõ. ÕðÜñ÷ïõí áíáöïñÝò ðïõ óõìöùíïýí ìå ôá
áðïôåëÝóìáôá ôçò ðáñïýóáò åñãáóßáò ùò ðñïò ôçí
åðï÷éêÞ êáôáíïìÞ ôùí éïãåíþí ëïéìþîåùí ôïõ ãá-
óôñåíôåñéêïý.18,19
ÓõìðåñáóìáôéêÜ, áðü ôçí ðáñïýóá ìåëÝôç öáßíå-
ôáé üôé ïé êýñéåò áéôßåò éïãåíþí ãáóôñåíôåñéêþí ëïé-
ìþîåùí, êõñßùò óå áóèåíåßò ðáéäéáôñéêþí êëéíéêþí,
åßíáé ïé rotavirus êõñßùò, áêïëïõèïýìåíïé áðü ade-
novirus. Ïé ëïéìþîåéò áõôÝò åìöáíßæïõí åðï÷éêÞ êá-
ôáíïìÞ, ìå óõ÷íüôåñç åìöÜíéóÞ ôïõò ôçí Üíïéîç êáé
ôï êáëïêáßñé. Áðáéôåßôáé ç ôá÷åßá äéÜãíùóç ôùí éïãå-
íþí ðáñáãüíôùí ðïõ ôéò ðñïêáëïýí, þóôå íá áðï-
öåýãåôáé ç Üóêïðç áíôéìéêñïâéáêÞ áãùãÞ êáé íá
ëçöèïýí ôá êáôÜëëçëá ìÝôñá ãéá ôçí áðïôñïðÞ åêäÞ-
ëùóçò åðéäçìéþí.
7-ereunitiki.qxd 14/10/2009 2:42 Page 219

?????? ?????? ???????? ???? ÁÉÔÉÁ ÉÏÃÅÍÙÍ

??????? ËÏÉÌÙÎÅÙÍ
???????????? ???ÔÏÕ ÃÁÓÔÑÅÍÔÅÑÉÊÏÕ
Blastocystis sp.

Summary

Gastroenteritis caused by rotavirus, adenovirus, norovirus and

astrovirus in the inpatients of a general hospital

M. Savvala1, I. Daniil1, I. Âerberidou1, A. Koutsibiri1, A. Stambolidi1, M. Papachristodoulou1,

N. Spanakis2, D. Petropoulou1, A. Tsakris2
1Microbiology Department, General Hospital of Nikea, Piraeus "Agios Panteleimon", Piraeus, Greece
2Microbiology Department, Medical School, University of Athens, Athens, Greece

The objective of the present study was tï determine the aetiology, prevalence and seasonal di-
stribution of viral gastrointestinal infections in hospitalized patients with acute diarrhoea. During a
12-month period, a total of 201 faecal specimens were collected from 165 children, 21 premature ne-
onates and 15 adults who were hospitalized with symptoms and signs of acute gastroenteritis. Sto-
ol samples were tested for the presence of rotavirus, adenovirus, astrovirus and norovirus. Rotavirus,
adenovirus and astrovirus antigen detection was performed by chromatographic immunoassays,
while noroviruses were detected by an enzyme immunoassay. Positive results for norovirus were
confirmed by reverse transcription-Polymerase Chain Reaction (RT-PCR). The available data were
analyzed for seasonality of infection and possible transmission mode. The overall incidence of viral
identification in acute diarrheal stool samples was 24% (48 of 201 patients). Fifty one viral antigens
were detected and the overall prevalence rates for rotavirus, adenovirus, norovirus and astrovirus
were 14.9%, 7.0%, 3.0% and 0.5% respectively. Noroviruses were detected in 3 patients during an
epidemic in December 2007 (one patient while he was in cruise and two premature neonates hospi-
talized in the neonatal unit). Mixed viral infection was detected in three adults: norovirus / astrovirus
in one patient, and rotavirus / adenovirus in two patients. The majority of cases of viral gastroenteri-
tis occurred in spring (37.5%) and in summer (27.1%), caused mainly by rotavirus, while norovirus
219
infections occurred during early autumn and winter. In conclusion, rotaviruses, followed by ade-
noviruses, were the main causative agents of viral gastrointestinal infections in our hospitalized
population, which consisted mostly of infants and young children. The aetiological diagnosis of ga-
stroenteritis allows the isolation of infected patients, the prevention of epidemics and the avoidance
of unnecessary antibiotic treatments.

Key words
Gastroenteritis, viruses, diarrhea.

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17. Verhoef L, Boxman IL, Duizer E, Rutjes SA, Vennema H, Friese-
ma IH, et al. Multiple exposures during a norovirus outbreak on a
river-cruise sailing through Europe, 2006. Euro Surveill 2008; 12:
13.
18. Lopman BA, Reacher M, Gallimore C, Adak GK, Gray JJ, Brown
DW. A summertime peak of "winter vomiting disease": surveillan-
ce of noroviruses in England and Wales, 1995 to 2002. BMC Public
Health 2003; 3: 13.
19. Rendi-Wagner P, Kundi M, Mikolasek A, Mutz I, Zwiauer K, Wi-
edermann U, et al. Active hospital-based surveillance of rotavirus
diarrhea in Austrian children, period 1997 to 2003. Wien Klin
Wochenschr 2006; 118: 280-285.
7-ereunitiki.qxd 14/10/2009 2:42 Page 221
7-ereunitiki.qxd 14/10/2009 2:43 Page 222
8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 223

ÅðéëåãìÝíç âéâëéïãñáöéêÞ åíçìÝñùóç

1) ÓïâáñÜ ðåñéóôáôéêÜ ðíåõìïíéêÞò ëïßìùîçò áðü ôïõò éïýò ôçò

ãñßðçò óôï Ìåîéêü: ðáñïýóá êáôÜóôáóç êáé óýãêñéóç ìå ôá
ðñïçãïýìåíá ÷ñüíéá

ÊáôÜ ôç äéÜñêåéá ôçò Üíïéîçò 2009, êáôáãñÜöç-
êáí óôï Ìåîéêü óïâáñÜ ðåñéóôáôéêÜ ðíåõìïíßáò
ôá ïðïßá ó÷åôßóôçêáí ìå ôçí ðáíäçìßá ôïõ íÝïõ
éïý ãñßðçò Á (Ç1Í1). ÓõãêåêñéìÝíá áðü ôéò 24
Ìáñôßïõ Ýùò ôéò 29 Áðñéëßïõ 2009 êáôáãñÜöçêáí
óõíïëéêÜ 2.155 ðåñéóôáôéêÜ óïâáñÞò ðíåõìïíé-
êÞò ëïßìùîçò, ìåôáîý ôùí ïðïßùí 821 íïóçëåýôç-
êáí êáé 100 êáôÝëçîáí, åíþ ôçí ßäéá ðåñßïäï
ðÜñèçêáí 8.817 ñéíïöáñõããéêÜ äåßãìáôá, áðü ôá
ïðïßá 2.582 Þôáí èåôéêÜ ãéá ôï íÝï éü ãñßðçò Á
(Ç1Í1). ×ñçóéìïðïéþíôáò ôá äåäïìÝíá ôïõ Åèíé-
êïý ÓõóôÞìáôïò ÅðéôÞñçóçò êáé ôïõ Õðïõñãåßïõ
Õãåßáò ôïõ Ìåîéêïý, Ýãéíå óýãêñéóç ôùí óôïé÷åß-
ùí íïóçñüôçôáò êáé èíçôüôçôáò ôùí ðåñéóôáôé-
êþí óïâáñÞò ðíåõìïíéêÞò ëïßìùîçò ôçò
óõãêåêñéìÝíçò ðåñéüäïõ 2009 ìå áõôÜ ôçò åðï÷é-
êÞò ãñßðçò ôùí ðñïçãïýìåíùí ôåóóÜñùí åôþí.
Ç çëéêéáêÞ êáôáíïìÞ ôùí ðïóïóôþí íïóçñü-
ôçôáò êáé èíçôüôçôáò êáôÜ ôç äéÜñêåéá ôçò åðé-
äçìßáò ôïõ 2009 Þôáí äéáöïñåôéêÞ áðü áõôÝò
ôùí ðåñéüäùí ãñßðçò ôùí ðñïçãïýìåíùí åôþí,
ìå áýîçóç ôïõò óôéò çëéêéáêÝò ïìÜäåò 5 ìå 59
Ýôç. ÓõãêåêñéìÝíá 87% ôùí èáíÜôùí êáé 71%
ôùí ðåñéóôáôéêþí óïâáñÞò ðíåõìïíéêÞò ëïßìù-
îçò óõíÝâçóáí óôç óõãêåêñéìÝíç çëéêéáêÞ ïìÜ-
äá, åíþ ôá áíôßóôïé÷á ðïóïóôÜ ôùí ðåñéüäùí
ôçò åðï÷éêÞò ãñßðçò 2006-2008 Þôáí 17% êáé
32%, áíôßóôïé÷á.
ÓõìðåñáóìáôéêÜ, êáôÜ ôç äéÜñêåéá ôçò ðñþ-
éìçò öÜóçò ôçò ðáñïýóáò ðáíäçìßáò ãñßðçò 223
õðÞñîå áýîçóç ôïõ ðïóïóôïý óïâáñÞò ðíåõìï-
íéêÞò ëïßìùîçò êáé áëëáãÞ ôçò çëéêßáò åìöÜíé-
óçò ôÝôïéùí ðåñéóôáôéêþí óå ó÷Ýóç ìå ôéò
ðñïçãïýìåíåò ðåñéüäïõò ôçò åðï÷éêÞò ãñßðçò.
Ôï ãåãïíüò áõôü ìÜëëïí ïöåßëåôáé óôçí ýðáñîç
ðñïóôáôåõôéêþí áíôéóùìÜôùí óôá Üôïìá ðïõ åß-
÷áí åêôåèåß óå óôåëÝ÷ç Ç1Í1 êáôÜ ôçí ðáéäéêÞ
ôïõò çëéêßá, ðñéí áðü ôçí ðáíäçìßá ôïõ 1957.
ÅðïìÝíùò åßíáé åðéâåâëçìÝíï ïé ðñïóðÜèåéåò
ðñüëçøçò ìå ôç ÷ïñÞãçóç åìâïëßïõ íá åðéêå-
íôñùèïýí óôéò íåüôåñåò çëéêéáêÜ ðëçèõóìéáêÝò
ïìÜäåò.
Chowell G., et al. Severe respiratory disease con-
current with the circulation of H1N1 influenza. N
Engl J Med 2009; 361

Ó÷üëéï: Óôçí ïöåéëüìåíç óôï íÝï éü ãñßðçò Á (Ç1Í1) åðéäçìßá ôïõ 2009 óôï Ìåîéêü – ðñþéìç öÜóç
ôçò ðáíäçìßáò ãñßðçò – ôï ðïóïóôü ôùí åðéðëïêþí, óõìðåñéëáìâáíïìÝíùí ôùí èáíÜôùí,
Þôáí õøçëüôåñï óôá Üôïìá 5-59 åôþí. Óå óýãêñéóç ìå ôá óôïé÷åßá ôçò åðï÷éêÞò ãñßðçò, öáß-
íåôáé üôé õðÜñ÷åé óáöÞò äéáöïñÜ, ìéá êáé ïé óïâáñÝò åðéðëïêÝò ôçò ëïßìùîçò áðü ôïí éü ôçò
åðï÷éêÞò ãñßðçò åìöáíßæïíôáé óôá ìåãáëýôåñçò çëéêßáò Üôïìá. ÔÝôïéá åðéäçìéïëïãéêÜ äåäï-

ÔÏÌÏÓ 54 54
ÔÏÌÏÓ • ÔÅÕ×ÏÓ 4, Éïýëéïò
• ÔÅÕ×ÏÓ - Áýãïõóôïò
4, Éïýëéïò 2009
- Áýãïõóôïò 2009
8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 224

ÅÐÉËÅÃÌÅÍÇ ÂÉÂËÉÏÃÑÁÖÉÊÇ ÅÍÇÌÅÑÙÓÇ

ìÝíá, üðùò áõôÜ ôçò ðáñïýóáò ìåëÝôçò, ìðïñåß íá áðïôåëÝóïõí óçìáíôéêÞ âïÞèåéá óôç ëÞ-
øç áðïöÜóåùí ó÷åôéêÜ ìå ôç óôñáôçãéêÞ åìâïëéáóìïý ðïõ ðñÝðåé íá áêïëïõèçèåß.

Larry M Baddour, MD
óôï Journal Watch, Infectious Diseases.
Áðü: the publishers of the New England Journal of Medicine, July 1, 2009
(http://infectious-diseases.jwatch.org/misc/board_about.dtl#aBaddour)

2) ÍåõñïëïãéêÝò åðéðëïêÝò óå ðáéäéÜ ìå ëïßìùîç áðü ôï íÝï éü

ãñßðçò Á (Ç1Í1)

Óôï MMWR óôéò 24 Éïõëßïõ 2009 Ýãéíå áíáöïñÜ
4 ðåñéóôáôéêþí ìå ëïßìùîç áðü ôï íÝï éü ãñßðçò
Á (Ç1Í1) ðïõ ðáñïõóßáóáí íåõñïëïãéêÝò åêäç-
ëþóåéò. ÓõãêåêñéìÝíá óôéò 28 ÌáÀïõ 2009 Ýãéíå
äÞëùóç áðü ôï Dallas Department of Health and
Human Services (DCHHS) óôï CDC ãéá 4 ðáéäéÜ
ðïõ íïóçëåýôçêáí áðü ôéò 18 Ýùò 28 ÌáÀïõ óå
íïóïêïìåßá ôïõ Texas çëéêßáò 7-17 åôþí ìå óõ-
ìðôùìáôïëïãßá ãñßðçò êáé óðáóìïýò Þ áëëáãÞ
ôïõ åðéðÝäïõ óõíåßäçóçò. Ôñßá áðü ôá ôÝóóåñá
áõôÜ ðáéäéÜ åß÷áí ðáèïëïãéêü çëåêôñïåãêåöáëï-
ãñÜöçìá. Óå üëá áíé÷íåýèçêå RNA ôïõ íÝïõ éïý
ãñßðçò Á (Ç1Í1) óå äåßãìá áðü ôï ñéíïöÜñõããá,
áëëÜ ü÷é óôï ÅÍÕ. Óå üëá ÷ïñçãÞèçêå áíôééêÞ
áãùãÞ: óå ôñßá ðáéäéÜ óõíäõáóìüò oseltamivir
êáé rimantadine, êáé óå Ýíá ðáéäß oseltamivir. Êáé
224 ôá ôÝóóåñá ðáéäéÜ áíÜññùóáí ðëÞñùò êáé äåí
ðáñïõóßáæáí êáíÝíá íåõñïëïãéêü õðüëåéììá êá-
ôÜ ôçí Ýîïäü ôïõò áðü ôï íïóïêïìåßï. Ôá óõãêå-
êñéìÝíá äåäïìÝíá äåß÷íïõí üôé ï íÝïò éüò ãñßðçò
Á (Ç1Í1), üðùò êáé ïé Üëëïé éïß ôçò åðï÷éêÞò ãñß-
ðçò, ìðïñåß íá ðñïêáëÝóåé íåõñïëïãéêÝò åðéðëï-
êÝò. ¢ñá ïé êëéíéêïß éáôñïß ðñÝðåé íá ôïí
óêÝöôïíôáé óôç äéáöïñïäéÜãíùóç óå áíÜëïãá
ðåñéóôáôéêÜ êáé íá óôÝëíïõí äåßãìá áðü ôï áíá-
ðíåõóôéêü, åíþ ðáñÜëëçëá ðñÝðåé íá îåêéíïýí
áíôééêÞ áãùãÞ, éäßùò áí ï áóèåíÞò íïóçëåýåôáé.
Ïé õðåýèõíïé äçëþíïõí üôé ðéèáíÜ èá ðáñïõ-
óéáóôïýí êáé Üëëá ðåñéóôáôéêÜ íåõñïëïãéêþí
åðéðëïêþí óå ðáéäéÜ, êáèþò ç ðáíäçìßá ôïõ íÝ-
ïõ éïý Á (Ç1Í1) èá óõíå÷ßæåé íá õößóôáôáé.
CDC. Neurologic complications associated with
novel influenza A (H1N1) virus infection in children
- Dallas, Texas, May 2009. MMWR, 2009; 58: 773-
778.

Ó÷üëéï óôï Journal Watch, Physician's First Watch.

Áðü: the publishers of the New England Journal of Medicine, July 24, 2009
(http://firstwatch.jwatch.org/cgi/content/full/2009/724/1)

3) Ëïßìùîç áðü ôï íÝï éü ãñßðçò Á (Ç1Í1) óôéò Ýãêõåò ãõíáßêåò

Ç êýçóç Ý÷åé óõó÷åôéóôåß ìå áýîçóç ôçò âáñýôç-
ôáò ëïßìùîçò áðü ôïõò éïýò ôçò ãñßðçò, ôüóï
êáôÜ ôç äéÜñêåéá ôùí åðï÷éêþí åðéäçìéþí, üóï
êáé ðñïçãïýìåíùí ðáíäçìéþí ãñßðçò. Ãéá ðáñÜ-
äåéãìá, áðü ôéò Ýãêõåò ãõíáßêåò ðïõ íüóçóáí
áðü ãñßðç êáôÜ ôç äéÜñêåéá ôçò ðáíäçìßáò ôïõ
1918, ðåñßðïõ ìéóÝò ðáñïõóßáóáí ðíåõìïíßá êáé
áðü áõôÝò ðåñéóóüôåñåò áðü ôéò ìéóÝò ðÝèáíáí.
Ðéï ðñüóöáôá, êáôÜ ôç äéÜñêåéá ôçò ðáíäçìßáò
ôïõ 1957, ïé ìéóïß áðü ôïõò èáíÜôïõò ôïõò ïöåé-
ëüìåíïõò óôç ãñßðç ìåôáîý ãõíáéêþí áíáðáñá-
ãùãéêÞò çëéêßáò óôç Minnesota ôùí ÇÐÁ
óõíÝâçóáí êáôÜ ôç äéÜñêåéá ôçò êýçóçò. Ôï
CDC, ãéá íá ãíùñßæåé ôé áêñéâþò óõìâáßíåé ìå ôçí
ðáñïýóá ðáíäçìßá áðü ôï íÝï éü ãñßðçò Á
(Ç1Í1), äéåíÞñãçóå åðáõîçìÝíç åðéôÞñçóç ìå-
ôáîý ôùí åãêýùí ãõíáéêþí óôéò ÇÐÁ.
Áðü ôéò 15 Áðñéëßïõ Ýùò ôéò 18 ÌáÀïõ 2009,

VOL. 54 • ISSUE 4, July - August 2009

8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 225

ÅÐÉËÅÃÌÅÍÇ
?????? ?????? ???????? ???? ??????? ÂÉÂËÉÏÃÑÁÖÉÊÇ
???????????? ÅÍÇÌÅÑÙÓÇ
??? Blastocystis sp.

äçëþèçêáí áðü 13 ðïëéôåßåò 34 ðåñéóôáôéêÜ ëïß- rimantadine êáé 1 óå óõíäõáóìü ìå amantidine)

ìùîçò áðü ôï íÝï éü ãñßðçò Á (Ç1Í1) óå Ýãêõåò
ãõíáßêåò (31 åðéâåâáéùìÝíá êáé 3 ðéèáíÜ). Ôï ðï-
óïóôü ðñïóâïëÞò ôïí ðñþôï ìÞíá ôçò ðáíäçìß-
áò Þôáí õøçëüôåñï óå ó÷Ýóç ìå áõôü ôïõ
ãåíéêïý ðëçèõóìïý (0.32 / 100.000 Ýãêõåò ãõíáß-
êåò vs 0.076 / 100.000 ðëçèõóìïý). Ç çëéêßá ôïõò
Þôáí 15-42 åôþí (äéÜìåóç ôéìÞ 26) êáé 44% Þôáí
éóðáíéêÞò êáôáãùãÞò. Ôá óõìðôþìáôá ðïõ ðá-
ñïõóßáóáí Þôáí ßäéá, üðùò êáé óôï ãåíéêü ðëç-
èõóìü, ìå ìüíç äéáöïñÜ ôç óõ÷íüôåñç åìöÜíéóç
âñá÷ýôåñçò áíáðíïÞò. ¸íôåêá áðü áõôÝò íïóç-
ëåýôçêáí êáé 6 ðÝèáíáí (4 âñßóêïíôáí óôï ôñßôï
ôñßìçíï ôçò êýçóçò), üëåò áðü ðñùôïðáèÞ éïãå-
íÞ ðíåõìïíßá êáé óýíäñïìï ïîåßáò áíáðíåõóôé-
êÞò äõó÷Ýñåéáò, ðïõ ÷ñåéÜóôçêå ìç÷áíéêÞ
õðïóôÞñéîç. Ìåôáîý áõôþí ðïõ êáôÝëçîáí, 1
Þôáí ðá÷ýóáñêç, 2 åß÷áí Üëëá ìç óïâáñÜ ðñï-
âëÞìáôá õãåßáò êáé 3 Þôáí áðüëõôá õãéåßò. Ï
÷ñüíïò áðü ôçí Ýíáñîç ôùí óõìðôùìÜôùí ìÝ÷ñé
ôçí áíÜãêç éáôñéêÞò âïÞèåéáò êõìÜíèçêå áðü ìßá
Ýùò 7 çìÝñåò (äéÜìåóç ôéìÞ 3.5). ÊáôÜ ôç äéÜñ-
êåéá ôçò ëïßìùîçò, êáé ïé 6 ãõíáßêåò Ýëáâáí èå-
ñáðåßá ìå oseltamivir (2 óå óõíäõáóìü ìå
ìÝóá óå äéÜñêåéá 6-15 çìÝñåò áðü ôçí Ýíáñîç
ôùí óõìðôùìÜôùí (äéÜìåóç ôéìÞ 9) êáé 2-14 çìÝ-
ñåò áðü ôçí ðñþôç áíáæÞôçóç éáôñéêÞò âïÞèåéáò
(äéÜìåóç ôéìÞ 4.5). Ôá 5 íåïãíÜ ðïõ ãåííÞèçêáí
(üëá ìå êáéóáñéêÞ) áðü ôéò ìçôÝñåò ðïõ êáôÝëç-
îáí äåí åß÷áí ìïëõíèåß áðü ôïí éü (Ýíá íåïãíü
êáôÝëçîå ôç óôéãìÞ èáíÜôïõ ôçò ìçôÝñáò ôïõ).
Ìåôáîý ôùí áóèåíþí ìå ëïßìùîç áðü ôï íÝï
éü ãñßðçò Á (Ç1Í1), ç áíÜãêç ãéá íïóçëåßá Þôáí
ðéï óõ÷íÞ óôéò Ýãêõåò ãõíáßêåò óå ó÷Ýóç ìå ôï
ãåíéêü ðëçèõóìü (32.4% vs 4.2%, áíôßóôïé÷á).
Ãéá ôçí ðåñßïäï ôçò ìåëÝôçò, 0.62% ôùí ðåñé-
óôáôéêþí åðéâåâáéùìÝíùí êáé ðéèáíþí êñïõóìÜ-
ôùí êáé 13% ôùí èáíÜôùí áöïñïýóå Ýãêõåò
ãõíáßêåò. ÓõìðåñáóìáôéêÜ, ïé Ýãêõåò ãõíáßêåò
ðáñïõóéÜæïõí áõîçìÝíï êßíäõíï åðéðëïêþí áðü
ôç ëïßìùîç ìå ôï íÝï éü ãñßðçò Á (Ç1Í1) êáé åðï-
ìÝíùò ÷ñÞæïõí Ýãêáéñá êáôÜëëçëçò áíôééêÞò
áãùãÞò.
Jamieson DJ, et al. H1N1 2009 influenza virus dur-
ing pregnancy in the USA. Lancet 2009; 374: 451-
458

Ó÷üëéï: Ç ÷ïñÞãçóç êáôÜëëçëçò áíôééêÞò èåñáðåßáò óå õðïøßá ëïßìùîçò áðü ôï íÝï éü ãñßðçò Á
(Ç1Í1) åßíáé åðéâåâëçìÝíç óôéò Ýãêõåò ãõíáßêåò, äåäïìÝíïõ ôüóï ôçò âáñýôçôáò ôçò íüóç-
óçò, üóï êáé ôçò áðïõóßáò áíåðéèýìçôùí ðáñåíåñãåéþí áðü ôç ÷ïñÞãçóç oseltamivir. Ç èå-
ñáðåßá ðñÝðåé íá áñ÷ßæåé ìÝóá óôï ðñþôï 48ùñï áðü ôçí Ýíáñîç ôùí óõìðôùìÜôùí, ÷ùñßò
âÝâáéá áõôü íá óçìáßíåé ðùò äåí èá ÷ïñçãçèåß êáé óå üóåò Ý÷ïõí îåðåñÜóåé áõôü ôï üñéï. Ôá
ôåëåõôáßá ÷ñüíéá, ëßãåò Ýãêõåò ãõíáßêåò Ý÷ïõí åìâïëéáóôåß ìå ôï åìâüëéï ôçò åðï÷éêÞò ãñß-
ðçò [14% ôï 2004 (Vaccine, 2008; 26: 1786)]. Ïé Ýãêõåò èá ðñÝðåé íá åßíáé áðü ôéò ðñþôåò ïìÜ-
äåò ðïõ èá åìâïëéáóôïýí ìå ôï åìâüëéï ãéá ôï íÝï éü, ìüëéò áõôü åßíáé äéáèÝóéìï. 225
ÅìâïëéÜæïíôáò, åîÜëëïõ, ôéò Ýãêõåò ãõíáßêåò, ìðïñåß íá ðñïöõëá÷èåß êáé ôï íåïãíü áðü ëïß-
ìùîç ìå ôï íÝï éü, ìåôÜ ôç ãÝííçóÞ ôïõ.
Mary E. Wilson, MD
óôï Journal Watch, Infectious Diseases.
Áðü: the publishers of the New England Journal of Medicine, August 5, 2009
(http://infectious-diseases.jwatch.org/misc/board_about.dtl#aWilson)

4) Ç Ýãêáéñç ÷ïñÞãçóç ïóåëôáìéâßñçò (tamiflu) ìðïñåß íá

ðñïöõëÜîåé ôá ðáéäéÜ ìå ÷ñüíéá íïóÞìáôá áðü åðéðëïêÝò
ìåôÜ áðü ëïßìùîç áðü ôïí éü ôçò ãñßðçò

Óå Ýñåõíá ãéá ôçí áðïôåëåóìáôéêüôçôá ôçò
Ýãêáéñçò ÷ïñÞãçóçò ïóåëôáìéâßñçò óôçí åìöÜ-
íéóç åðéðëïêþí óå ðáéäéÜ ìå ÷ñüíéá íïóÞìáôá,
êáôáãñÜöçêå ç Ýêâáóç ôçò ëïßìùîçò áðü éü ôçò
ãñßðçò óå 1.634 ðáéäéÜ ðïõ Ýëáâáí ôï óõãêåêñé-
ìÝíï áíôééêü ìÝóá óôçí ðñþôç ìÝñá áðü ôç äéÜ-
ãíùóç, óå ó÷Ýóç ìå áõôÞ 3.721 ðáéäéþí ÷ùñßò
èåñáðåßá. ¼ëá ôá ðáéäéÜ (çëéêßáò 1-17 åôþí)
Þôáí õøçëïý êéíäýíïõ ãéá ôçí åìöÜíéóç åðéðëï-
êþí, åîáéôßáò ôçò ýðáñîçò ÷ñüíéïõ íïóÞìáôïò

ÔÏÌÏÓ 54 • ÔÅÕ×ÏÓ 4, Éïýëéïò - Áýãïõóôïò 2009

8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 226

ÅÐÉËÅÃÌÅÍÇ ÂÉÂËÉÏÃÑÁÖÉÊÇ ÅÍÇÌÅÑÙÓÇ

(óõìðåñéëáìâÜíïíôáé ëïßìùîç áðü HIV Þ AIDS,
Üóèìá, êáñêßíïò). Ïé ÷ñïíéêïß ðåñßïäïé äéÜãíù-
óçò ëïßìùîçò áðü ôïí éü Þôáí ïé åðï÷éêÝò ðåñß-
ïäïé ãñßðçò 2000-2006.
ÊáôÜ ôç äéÜñêåéá 14 çìåñþí áðü ôç äéÜãíù-
óç, ôá ðáéäéÜ ðïõ Ýëáâáí ïóåëôáìéâßñç, óå ó÷Ý-
óç ìå áõôÜ ðïõ äåí Ýëáâáí, ðáñïõóßáóáí
ìéêñüôåñï ðïóïóôü íïóçëåßáò (0.6% vs 1.3%),
åìöÜíéóçò ðíåõìïíßáò (1.0% vs 1.9%), áíáðíåõ-
óôéêÞò íüóïõ Üëëçò åêôüò ðíåõìïíßáò (19.8% vs
23.8%) êáé ìÝóçò ùôßôéäáò (2.8% vs 4.9%). ÁíÜ-
ëõóç ãéá ðéèáíïýò óõã÷õôéêïýò ðáñÜãïíôåò,
Ýäåéîå üôé ïé äéáöïñÝò áõôÝò Þôáí óôáôéóôéêÜ óç-
ìáíôéêÝò, åêôüò áðü ôçí åìöÜíéóç ðíåõìïíßáò.
ºäéá Þôáí ôá áðïôåëÝóìáôá êáé 30 çìÝñåò ìåôÜ
ôç äéÜãíùóç.
Piedra PA, et al. Effects of oseltamivir on influenza-
related complications in children with chronic me-
dical conditions. Pediatrics 2009; 124: 170-178.

Ó÷üëéï: Ïé ìåëåôçôÝò, ìå ôçí ðáñáðÜíù Ýñåõíá áîéïëüãçóçò ôçò áðïôåëåóìáôéêüôçôáò ôçò ïóåëôáìé-
âßñçò, âñÞêáí üôé ôï óõãêåêñéìÝíï áíôééêü öÜñìáêï ðñïëáìâÜíåé ôéò åðéðëïêÝò ôçò ãñßðçò óå
õøçëïý êéíäýíïõ ðáéäéÜ. Ôá ðáéäéÜ áõôÜ åß÷áí íïóÞóåé áðü éïýò åðï÷éêÞò ãñßðçò ôùí åôþí
2000 - 2006 êáé ü÷é áðü ôï íÝï éü ãñßðçò Á (Ç1Í1). Óýìöùíá ìå äåäïìÝíá, ðïõ õðÜñ÷ïõí óôïí
éóôüôïðï ôïõ CDC, ïóåëôáìéâßñç ÷ïñçãåßôáé ãéá èåñáðåßá êáé ðñüëçøç åðéðëïêþí ëïßìùîçò
áðü ôï íÝï éü ãñßðçò Á (Ç1Í1) óå åíÞëéêåò êáé ðáéäéÜ, óõìðåñéëáìâáíïìÝíùí êáé ôùí êÜôù ôïõ
åíüò Ýôïõò (http://www.cdc.org/swineflu/eua/tamiflu.htm)
Howard Bauchner, MD
óôï Journal Watch, Pediatrics and Adolescent Medicine.
Áðü: the publishers of the New England Journal of Medicine, August 5, 2009
(http://pediatrics.jwatch.org/misc/board_about.dtl#aBauchner)

5) Ðïéá åßíáé ç èÝóç ôçò ÷ïñÞãçóçò áíôéìéêñïâéáêþí óôç

èåñáðåßá ðáéäéþí ìå ðáñáññéíïêïëðßôéäá;

Ç áðïôåëåóìáôéêüôçôá ôçò ÷ïñÞãçóçò áíôéâéïôé- ÐåíÞíôá áóèåíåßò (89%) ðáñïõóßáóáí åììÝ-

êþí óå ðáéäéÜ ìå ðáñáññéíïêïëðßôéäá åßíáé áâÝ-
226 âáéç. Óôçí ðáñïýóá, ôõ÷áéïðïéçìÝíç, äéðëÞ -
ôõöëÞ ìåëÝôç, 56 ðáéäéÜ (çëéêßáò 1-10 åôþí) ìå
êëéíéêÞ äéÜãíùóç ðáñáññéíïêïëðßôéäáò Ýëáâáí
ãéá 14 çìÝñåò åßôå áìïîéêéëëßíç (90mg/kg âÜñïõò
óþìáôïò) ìáæß ìå êëáâïõëáíéêü (6.4mg/kg âÜ-
ñïõò óþìáôïò), åßôå åéêïíéêü öÜñìáêï (placebo).
Ç ðáñáññéíïêïëðßôéäá äéá÷ùñßóôçêå ùò åììÝ-
íïõóá, áí ôá óõìðôþìáôá (ñéíéêü Ýêêñéìá êáé êá-
èçìåñéíüò âÞ÷áò) åß÷áí äéÜñêåéá ìåãáëýôåñç ôùí
10 çìåñþí, åðéäåéíïýìåíç, áí ôá óõìðôþìáôá
÷åéñïôÝñåõáí ôçí 6ç çìÝñá Þ ìåôÜ áðü áõôÞ, êáé
óïâáñÞ áí ðáñïõóéáæüôáí ðõñåôüò >39ïC êáé
ðõþäåò ñéíéêü Ýêêñéìá ãéá ôïõëÜ÷éóôïí 3 óõíå-
÷üìåíåò çìÝñåò. Áðü ôá 2.135 ðáéäéÜ ìå ëïßìùîç
ôïõ áíþôåñïõ áíáðíåõóôéêïý ðïõ Þôáí õðïøÞ-
öéá ãéá ôçí ìåëÝôç, ìüíï 139 (6.5%) ðëçñïýóáí
ôá êñéôÞñéá ãéá ðáñáññéíïêïëðßôéäá. ÊáôáãñáöÞ
ôçò óõìðôùìáôïëïãßáò ôùí ðáéäéþí, ìÝóù ôùí
ãïíÝùí ôïõò, Ýãéíå ôéò çìÝñåò 0, 1, 2, 3, 5, 7, 10,
20 êáé 30, åíþ êëéíéêÞ åîÝôáóç ôùí ðáéäéþí Ýãéíå
ôçí 14ç çìÝñá áðü ôçí Ýíáñîç ôçò áãùãÞò. Ç êá-
ôÜóôáóç ôùí ðáéäéþí ÷áñáêôçñßóôçêå ùò éáèåß-
óá, áí ç âáèìïëïãßá óïâáñüôçôáò ôçò êëéíéêÞò
åéêüíáò ìåéþèçêå êáôÜ ôïõëÜ÷éóôïí 50%.
íïõóá, åíþ 32 (57%) óïâáñÞ åéêüíá ëïßìùîçò.
Áðü ôá 28 ðáéäéÜ ðïõ Ýëáâáí áíôéâßùóç, 14
(50%) èåñáðåýôçêáí, 4 (14%) âåëôéþèçêáí, 4
(14%) ðáñïõóßáóáí èåñáðåõôéêÞ áðïôõ÷ßá êáé
6 (21%) õðïôñïðßáóáí. Áðü ôá 28 ðáéäéÜ ðïõ
Ýëáâáí placebo, 4 (14%) èåñáðåýôçêáí, 5
(18%) âåëôéþèçêáí êáé 19 (68%) ðáñïõóßáóáí
èåñáðåõôéêÞ áðïôõ÷ßá. ÅðïìÝíùò ôá ðáéäéÜ
ðïõ Ýëáâáí áíôéâßùóç, óå ó÷Ýóç ìå áõôÜ ðïõ
ðÞñáí placebo, åß÷áí ìåãáëýôåñç ðéèáíüôçôá
íá èåñáðåõôïýí (50% vs 14%) êáé ìéêñüôåñç íá
ðáñïõóéÜóïõí èåñáðåõôéêÞ áðïôõ÷ßá (14% vs
68%). ÐáñåíÝñãåéåò, üðùò äéÜññïéá, Þôáí ðéï
óõ÷íÝò óôçí ïìÜäá ðïõ Ýëáâå áíôéâßùóç (44%
vs 14%).
ÓõìðåñáóìáôéêÜ, ç ÷ïñÞãçóç áìïîõêéëëß-
íçò/êëáâïõëáíéêïý óå ðáéäéÜ ìå ðáñáññéíïêïë-
ðßôéäá Ý÷åé ðåñéóóüôåñåò èåñáðåõôéêÝò åðéôõ÷ßåò
ðáñÜ áðïôõ÷ßåò, óå ó÷Ýóç ìå ôï placebo, óýì-
öùíá áðü ôç äÞëùóç ôùí ãïíÝùí ó÷åôéêÜ ìå ôç
ëýóç ôùí êëéíéêþí óõìðôùìÜôùí.
Wald ER., et al. Effectiveness of amoxicillin/clavula-
nate potassium in the treatment of acute bacterial
sinusistis in children. Pediatrics 2009; 124: 9-15

VOL. 54 • ISSUE 4, July - August 2009

8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 227

ÅÐÉËÅÃÌÅÍÇ
?????? ?????? ???????? ???? ??????? ÂÉÂËÉÏÃÑÁÖÉÊÇ
???????????? ÅÍÇÌÅÑÙÓÇ
??? Blastocystis sp.

Ó÷üëéï: Áðü ôçí ðáñïýóá ìåëÝôç åîÜãïíôáé äýï óõìðåñÜóìáôá: á) ç ðáñáññéíïêïëðßôéäá óôá ðáéäéÜ
äåí åßíáé ôüóï óõ÷íÞ åðéðëïêÞ éïãåíïýò ëïßìùîçò ôïõ áíþôåñïõ áíáðíåõóôéêïý êáé â) ç ÷ï-
ñÞãçóç áíôéâéïôéêþí âåëôéþíåé ôçí êëéíéêÞ ôçò Ýêâáóç.
Howard Bauchner, MD
óôï Journal Watch, Pediatrics and Adolescent Medicine.
Áðü: the publishers of the New England Journal of Medicine, July 22, 2009
(http://pediatrics.jwatch.org/misc/board_about.dtl#aBauchner)

6) ×ïñÞãçóç áíôéâéïôéêþí óå ðáéäéÜ ìå ïîåßá ìÝóç ùôßôéäá

áõîÜíåé ôïí êßíäõíï õðïôñïðÞò

Ç ïîåßá ìÝóç ùôßôéäá (ÏÌÙ) áðïôåëåß ôçí ðñþ-
ôç áéôßá åðßóêåøçò óôïí ðáéäßáôñï, êáèþò êáé
ëÞøçò áíôéâéïôéêþí. Ïé ðñüóöáôåò ïäçãßåò óõ-
óôÞíïõí ôç ÷ïñÞãçóç áíôéâéïôéêþí óå ðáéäéÜ ìå
óïâáñÞ ëïßìùîç êáé óå üóá åßíáé ìéêñüôåñá ôùí
äýï åôþí êáé ðáñïõóéÜæïõí áìöïôåñüðëåõñç
ÏÌÙ Þ ïîåßá ùôüññïéá, åíþ ãéá ôá õðüëïéðá åß-
íáé áðáñáßôçôç ç êëéíéêÞ åîÝôáóç. ¼ìùò, ðáñÜ
ôéò ïäçãßåò, åßíáé óõ÷íÞ ç ÷ïñÞãçóç áíôéâéïôé-
êþí óå ðåñéðôþóåéò ÏÌÙ ðïõ äåí åìðßðôïõí
óôéò ðáñáðÜíù êáôçãïñßåò, ìå Üãíùóôá, ìÝ÷ñé
ôþñá, ôá ìáêñï÷ñüíéá áðïôåëÝóìáôÜ ôçò. Ãéá ôï
óêïðü áõôü ðñáãìáôïðïéÞèçêå óôçí Ïëëáíäßá
Ýñåõíá, êáôÜ ôç äéÜñêåéá ôçò ïðïßáò óôÜëèçêáí
åñùôçìáôïëüãéá óôïõò ãïíåßò 240 ðáéäéþí, çëé-
êßáò 6 ìçíþí Ýùò 2 åôþí, ðïõ åß÷áí óõììåôÜó÷åé
ìåôáîý Öåâñïõáñßïõ 1996 êáé ÌáÀïõ 1998 óå
ðïëõêåíôñéêÞ äéðëÞ - ôõöëÞ ìåëÝôç ÷ïñÞãçóçò
áìïîéêéëëßíçò (40mg/kg/çìÝñá óå 3 äüóåéò) Þ
placebo ãéá ôç èåñáðåßá ÏÌÙ. Ôá áðïôåëÝóìá-
ôá ôçò 4çò êáé 11çò çìÝñáò èåñáðåßáò, êáèþò
êáé 6 ìçíþí ìåôÜ äçìïóéåýôçêáí ôï 2000 êáé
2006, áíôßóôïé÷á (Damoiseaux RA, et al, 2000 êáé
2006). Ôï åñùôçìáôïëüãéï óôÜëèçêå ôï 2000,
3,5 ðåñßðïõ ÷ñüíéá ìåôÜ ôçí Ýíáñîç ôçò ìåëÝ-
ôçò, êáé áöïñïýóå åðåéóüäéá õðïôñïðþí ÏÌÙ,
áíÜãêç ãéá äåýôåñç åðßóêåøç, êáèþò êáé ÷åé-
ñïõñãåßï óå áõôß, ìýôç Þ ëáéìü. Áðü ôéò 240 ïé-
êïãÝíåéåò, áðÜíôçóáí 168 (70%), åíþ, áêüìç êáé
óå áõôü ôï óôÜäéï ôçò ìåëÝôçò, 95% ôùí ãïíÝùí
äå ãíþñéæáí ôï åßäïò ôçò èåñáðåßáò ðïõ åß÷å ëÜ-
âåé áñ÷éêÜ ôï ðáéäß ôïõò.
Ïé ãïíåßò ôùí ðáéäéþí ðïõ Ýëáâáí áìïîéêéë-
ëßíç áíÝöåñáí óå ìåãáëýôåñï ðïóïóôü õðï-
ôñïðÞ ôçò ÏÌÙ (47/75, 63%), óå ó÷Ýóç ìå
áõôïýò ðïõ ôá ðáéäéÜ ôïõò ðÞñáí placebo
(37/86, 43%). Ðáñüìïéïò Þôáí ï áñéèìüò ôùí
ðáéäéþí ðïõ ÷ñåéÜóôçêáí äåýôåñç åðßóêåøç,
ôüóï óôçí ïìÜäá ðïõ Ýëáâå, üóï êáé óå áõôÞ
ðïõ äåí Ýëáâå èåñáðåßá (24/78, 31% êáé 27/89,
30%, áíôßóôïé÷á). ÔÝëïò, ôï ÷åéñïõñãåßï Þôáí
ëéãüôåñï óõ÷íü óôçí ïìÜäá ôùí ðáéäéþí ðïõ
ðÞñáí èåñáðåßá (16/78, 21%), óå ó÷Ýóç ìå áõ-
ôÞ ÷ùñßò èåñáðåßá (27/90, 30%). Áêüìç êáé ìå-
ôÜ ôç ñýèìéóç ôùí óõã÷õôéêþí ðáñáãüíôùí, ôá
ðáéäéÜ ðïõ Ýëáâáí áìïîéêéëëßíç åß÷áí 2,5 öï-
227
ñÝò ìåãáëýôåñï êßíäõíï ãéá õðïôñïðÞ, óå ó÷Ý-
óç ìå áõôÜ ðïõ äåí Ýëáâáí èåñáðåßá. ÂÝâáéá ïé
óõããñáöåßò ôïíßæïõí üôé äå ìðïñåß íá ãßíåé ãå-
íßêåõóç ôùí åõñçìÜôùí ôïõò óå ðáéäéÜ ìå õðï-
êåßìåíá íïóÞìáôá, êáèþò êáé óå üóá æïõí óå
÷áìçëïý êïéíùíéêïïéêïíïìéêïý åðéðÝäïõ ðåñé-
âÜëëïí.
Bezakova N, et al. Reccurence to 3.5 years after
antibiotic treatment of acute otitis media in very
young Dutch children: survey of trial participants.
BMJ, 2009; 339: b2525

Ó÷üëéï: Ç ìåëÝôç áõôÞ ðñïóèÝôåé áêüìç Ýíá åðé÷åßñçìá óôçí Üðïøç ìç ÷ïñÞãçóçò áíôéâéïôéêþí óå
ðåñéðôþóåéò áðëÞò ÏÌÙ. Ç ëÞøç áíôéâéïôéêþí áõîÜíåé ôçí ðéèáíüôçôá áðïéêéóìïý ìå áíèå-
êôéêÜ ðáèïãüíá êáé õðïôñïðÞò ôçò ìÝóçò ùôßôéäáò, êáé, êáô' åðÝêôáóç, áýîçóçò ôùí áíôï÷þí
óôï ãåíéêü ðëçèõóìü. Óå áíåðßðëåêôåò ðåñéðôþóåéò ÏÌÙ, ç ßáóç ÷ùñßò ôç ÷ïñÞãçóç áíôéâéï-
ôéêþí åßíáé ï êáíüíáò êáé, åðïìÝíùò, ç ðñáêôéêÞ ôçò áíáìïíÞò êáé ôçò åðáíåîÝôáóçò åßíáé
ðñïôéìüôåñç áðü ôçí Üìåóç Ýíáñîç Ü÷ñçóôçò áíôéâéïôéêÞò áãùãÞò.
Kristi L. Koenig, MD, FACEP
óôï Journal Watch, Emergency Medicine.
Áðü: the publishers of the New England Journal of Medicine, August 7, 2009
(http://emergency.jwatch.org/misc/board_about.dtl#aKoenig)

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8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 228

ÅÐÉËÅÃÌÅÍÇ ÂÉÂËÉÏÃÑÁÖÉÊÇ ÅÍÇÌÅÑÙÓÇ

7) Ìðïñåß ç ìïîéöëïîáóßíç íá áíôéêáôáóôÞóåé ôçí éóïíéáæßäç óôç

èåñáðåßá ôçò ðíåõìïíéêÞò öõìáôßùóçò;

Ç ìïîéöëïîáóßíç, üðùò åßíáé ãíùóôü, Ý÷åé ìáêñý
÷ñüíï çìßóåéáò æùÞò óôïí ïñü, ðñïêáëåß ëßãåò
áíåðéèýìçôåò áëëçëåðéäñÜóåéò ìå Üëëá öÜñìá-
êá êáé äå ÷ñåéÜæåôáé ðñïóáñìïãÞ ôçò äüóçò ôçò
óå ðåñßðôùóç íåöñéêÞò Þ çðáôéêÞò áíåðÜñêåéáò.
Óå ðåéñáìáôéêü ìïíôÝëï ðïíôéêþí ìå öõìáôßùóç
(ÔÂ), áíôéêáôÜóôáóç ôçò éóïíéáæßäçò ìå ìïîéöëï-
îáóßíç åëÜôôùóå ôï ÷ñüíï áðïóôåßñùóçò ôùí
ðíåõìüíùí êáé åðÝôñåøå ôç ìåßùóç ôïõ ÷ñüíïõ
èåñáðåßáò óå 4 ìÞíåò. Èá ìðïñïýóå, ëïéðüí, ç
ìïîéöëïîáóßíç íá áíôéêáôáóôÞóåé ôçí éóïíéáæßäç
óôç èåñáðåßá ðíåõìïíéêÞò ÔÂ óôïí Üíèñùðï;
Ãéá ôï óêïðü áõôü, ç ïìÜäá äéåèíïýò óõíåñ-
ãáóßáò ãéá ôçí Ýñåõíá óôç ÔÂ (Tuberculosis Tri-
als Consortium) äéåîÞãáãå äéðëÞ - ôõöëÞ ìåëÝôç
ðïõ óõìðåñéÝëáâå åíÞëéêåò áóèåíåßò êáôÜ ôï
ðñþôï 2ìçíï óõíäõáóìÝíçò áãùãÞò ãéá åíåñãü
ðíåõìïíéêÞ ÔÂ. ÓõíïëéêÜ 328 áóèåíåßò ìå èåôéêÜ
ãéá ïîåÜíôï÷á ðôýåëá ìïéñÜóôçêáí óå äýï ïìÜ-
äåò: ìéóïß ðïõ Ýëáâáí ìïîéöëïîáóßíç (400 mg)
êáé ïé õðüëïéðïé ìéóïß ðïõ Ýëáâáí éóïíéáæßäç (300
mg). Óå üëïõò ÷ïñçãÞèçêáí ìáæß ñéöáìðéêßíç,
åèáìâïõôüëç êáé ðõñéäïîßíç. Ç èåñáðåßá äüèçêå
óõíïëéêÜ 8 åâäïìÜäåò, 5 çìÝñåò ôçí åâäïìÜäá.
Ç ðñïÝëåõóç ôùí áóèåíþí Þôáí áðü ôçí ÁöñéêÞ
(65%), Âüñåéï ÁìåñéêÞ, Âñáæéëßá êáé Éóðáíßá.
Ôï ðñþôï èåôéêü áðïôÝëåóìá ôçò èåñáðåßáò,
áñíçôéêïðïßçóç ôçò êáëëéÝñãåéáò ìåôÜ áðü 8
åâäïìÜäåò, åðéôåý÷èçêå óå ðïóïóôü 60% óôçí
ïìÜäá ôùí áóèåíþí ðïõ Ýëáâå ìïîéöëïîáóßíç êáé
óå ðïóïóôü 55% óôçí ïìÜäá ôùí áóèåíþí ðïõ
Ýëáâå éóïíéáæßäç (p = 0.37). Ôá ðïóïóôÜ åëëéðïýò
óõììüñöùóçò Þôáí ßäéá êáé óôéò äýï ïìÜäåò
(15% êáé 11% áíôßóôïé÷á, p = 0.25). Åíôïýôïéò, ç
íáõôßá Þôáí óõ÷íüôåñç óôçí ïìÜäá ôùí áóèåíþí
ðïõ Ýëáâå ìïîéöëïîáóßíç (p = 0.03). Óõìðåñá-
óìáôéêÜ, áíôéêáôÜóôáóç ôçò éóïíéáæßäçò ìå ìïîé-
öëïîáóßíç ïäÞãçóå óå áýîçóç, Ýóôù êáé ìç
óôáôéóôéêÜ óçìáíôéêÞò, ôïõ ðïóïóôïý áñíçôéêÞò
êáëëéÝñãåéáò óå 8 åâäïìÜäåò áðü ôçí Ýíáñîç ôçò
èåñáðåßáò ãéá ðíåõìïíéêÞ ÔÂ.
Dorman SE, et al. Substitution of moxifloxacin for
isoniazid during intensive phase treatment of
pulmonary tuberculosis. Am J Respir Crit Care
Med, 2009; 180: 273-280.

Ó÷üëéï: Áíôßèåôá áðü ôá ðåéñáìáôéêÜ áðïôåëÝóìáôá óå ðïíôßêéá êáé áðü ðñïçãïýìåíç ìåëÝôç, óýì-
öùíá ìå ôçí ïðïßá ç ìïîéöëïîáóßíç ìðïñåß íá áíôéêáôáóôÞóåé ôçí åèáìâïõôüëç (Chang KC,
228 2009), ç ðáñïýóá ìåëÝôç äåí äåß÷íåé êÜðïéï ðëåïíÝêôçìá áðü ôçí áíôéêáôÜóôáóç ôçò éóïíé-
áæßäçò ìå ìïîéöëïîáóßíç. Åíôïýôïéò, ç ìïîéöëïîáóßíç ìðïñåß íá åßíáé ìéá êáëÞ åíáëëáêôéêÞ
ëýóç óå áóèåíåßò ðïõ äåí Ý÷ïõí áíï÷Þ óôçí éóïíéáæßäç Þ ðïõ Ý÷ïõí ìïëõíèåß ìå óôåëÝ÷ç Ì.
tuberculosis áíèåêôéêÜ óå áõôÞ.
Neil M. Ampel, MD, FACEP
óôï Journal Watch, Infectious Diseases.
Áðü: the publishers of the New England Journal of Medicine, August 19, 2009
(http://infectious-diseases.jwatch.org/misc/board_about.dtl#aAmpel)

8) ¢ñíçóç åìâïëéáóìïý ãéá êïêêýôç áõîÜíåé ôïí êßíäõíï

íüóçóçò óå áíåìâïëßáóôá ðáéäéÜ

Ïé ãïíåßò èÝôïõí óõ÷íÜ ôçí åñþôçóç áí ç Üñíç-
óç áíïóïðïßçóçò ôïõ ðáéäéïý ôïõò áõîÜíåé ôïí
êßíäõíï íüóçóçò áðü íïóÞìáôá ðïõ ìðïñåß íá
ðñïâëåöèïýí ìå ôïí åìâïëéáóìü. Ãéá ôï óêïðü
áõôü äéåîÜ÷èçêå áíáäñïìéêÞ ìåëÝôç óå 156 ðáé-
äéÜ (çëéêßá 2 ìçíþí Ýùò 18 åôþí) ðïõ íüóçóáí
ìå áðïäåäåéãìÝíï ìå êáëëéÝñãåéá êïêêýôç êáé óå
595 ðáéäéÜ, ùò ïìÜäá åëÝã÷ïõ, ìåôáîý ôùí åôþí
1996-2007 áðü ôï Éíóôéôïýôï Õãåßáò Kaiser Per-
manente ôïõ Colorando. Ç êáôáãñáöÞ ôùí óôïé-

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8-epilegmeni bibliografia.qxd 14/10/2009 2:44 Page 229

ÅÐÉËÅÃÌÅÍÇ
?????? ?????? ???????? ???? ??????? ÂÉÂËÉÏÃÑÁÖÉÊÇ
???????????? ÅÍÇÌÅÑÙÓÇ
??? Blastocystis sp.

÷åßùí çìåñïìçíßáò åìâïëéáóìïý Þ Üñíçóçò ôïõ ðáéäéÜ. ÓõíïëéêÜ, ïé óõããñáöåßò õðïóôçñßæïõí

Ýãéíå áðü ôï éáôñéêü öÜêåëï ôùí ðáéäéþí. Óõíï-
ëéêÜ, ìåôáîý ôùí ðáéäéþí ðïõ íüóçóáí õðÞñ÷áí
18 (12%) ïé ãïíåßò ôùí ïðïßùí áñíÞèçêáí íá åì-
âïëéáóôïýí, óå óýãêñéóç ìå 3 ðáéäéÜ (0.5%) ôçò
ïìÜäáò åëÝã÷ïõ. ÓõìðåñáóìáôéêÜ, ôá ðáéäéÜ ôùí
ãïíÝùí ðïõ áñíÞèçêáí ôïí åìâïëéáóìü ìå ôï åì-
âüëéï ôïõ êïêêýôç ðáñïõóéÜæïõí õøçëüôåñï êßí-
äõíï íüóçóçò óå ó÷Ýóç ìå ôá åìâïëéáóìÝíá
üôé, 11% ôùí ðåñéóôáôéêþí êïêêýôç ôïõ ðáéäéá-
ôñéêïý ðëçèõóìïý ôïõ Coloranto Keiser Perma-
nent åßíáé áðïôÝëåóìá Üñíçóçò åìâïëéáóìïý.
Glanz JM, et al. Parental refusal of pertussis vac-
cination is associated with an increased risk of
pertussis infection in children. Pediatrics, 2009;
123: 1446-1451.

Ó÷üëéï: Ìå ôçí ðáñáðÜíù ìåëÝôç öÜíçêå üôé, áí êáé åßíáé ìéêñü ôï ðïóïóôü áíåìâïëßáóôùí ãéá êïê-
êýôç ðáéäéþí, ç "áíïóßá áãÝëçò" äåí öáßíåôáé íá ôá ðñïöõëÜóóåé áðü ôç íüóçóç. ÅðïìÝíùò,
÷ñåéÜæåôáé íá ãßíïõí êáëýôåñá êáôáíïçôïß ïé ëüãïé Üñíçóçò åìâïëéáóìïý áðü ôç ìåñéÜ ôùí
ãïíÝùí êáé íá áíáðôõ÷èïýí áðïôåëåóìáôéêüôåñåò óôñáôçãéêÝò êÜìøçò ôïõò.
Howard Bauchner, MD
óôï Journal Watch, Pediatrics and Adolescent Medicine.
Áðü: the publishers of the New England Journal of Medicine, July 1, 2009
(http://pediatrics.jwatch.org/misc/board_about.dtl#aBauchner)

9) ×ñçóéìüôçôá ôçò äïêéìáóßáò ãëõêïæçëéùìÝíçò áéìïóöáéñßíçò

(HbA1c) óôç äéÜãíùóç ôïõ óáê÷áñþäç äéáâÞôç

Ç äéÜãíùóç ôïõ óáê÷áñþäç äéáâÞôç åßíáé äý-
óêïëç, éäéáßôåñá óôá ðáéäéÜ. Ïé óõíÞèùò ÷ñçóé-
ìïðïéïýìåíåò äïêéìáóßåò, ìÝôñçóç ãëõêüæçò
ðëÜóìáôïò êáé áíï÷Þ ãëõêüæçò, ÷ñåéÜæïíôáé
åðáíåéëëçìÝíåò ìåôñÞóåéò êáé åðïìÝíùò åðéóêÝ-
øåéò óôïõò áíôßóôïé÷ïõò éáôñïýò. Óå ðñüóöáôç
óõíÜíôçóç ôçò Äéåèíïýò ÅðéôñïðÞò Åéäéêþí
(International Expert Committee) õðü ôçí áéãßäá
äéåèíþí ïñãáíþóåùí (American Diabetes Asso-
ciation, European Association for the Study of
Diabetes, International Diabetes Federation) áðï-
öáóßóôçêå ç õéïèÝôçóç ôçò ìÝôñçóçò ôçò ãëõêï-
æçëéùìÝíçò áéìïóöáéñßíçò (HbA1c) óôç
äéÜãíùóç ôïõ óáê÷áñþäç äéáâÞôç. Ç åðéôñïðÞ
ôüíéóå üôé ôï óõãêåêñéìÝíï áðïôåëåß ïìüöùíç
Üðïøç, ÷ùñßò íá óçìáßíåé üôé ðñÝðåé íá ôçí
áóðáóôïýí ïé äéÜöïñåò, ó÷åôéêÝò ìå ôï äéáâÞ-
ôç, ïñãáíþóåéò.
Ç International Expert Committee äçìïóßåõ-
óå áíáóêüðçóç ó÷åôéêÜ ìå ôç äéÜãíùóç ôïõ äéá-
âÞôç ôéò ôåëåõôáßåò ôñåéò äåêáåôßåò êáé
ðáñïõóßáóå äåäïìÝíá áðü ôçí åãêõñüôçôá êáé
ôçí áîéïðéóôßá ôùí äïêéìáóéþí ãëõêüæçò ðëÜ-
óìáôïò êáé HbA1c. Ôï 1979 ç ÅèíéêÞ ÏìÜäá Äå-
äïìÝíùí ãéá ôï ÄéáâÞôç (National Diabetes Data
Group) üñéóå ôá äéáãíùóôéêÜ êñéôÞñéá ãéá ôï äéá-
âÞôç óýìöùíá ìå ôá åðßðåäá ãëõêüæçò ðëÜóìá-
ôïò, ôá ïðïßá ßó÷õóáí ãéá ðÜíù áðü 20 ÷ñüíéá.
Ôï 1997, ç ÅéäéêÞ ÅðéôñïðÞ ãéá ôç ÄéÜãíùóç êáé
229
Ôáîéíüìçóç ôïõ Óáê÷áñþäç ÄéáâÞôç (Expert
Committee on the Diagnosis and Classification of
Diabetes Mellitus) Üëëáîå ôá êñéôÞñéá, äßíïíôáò
Ýìöáóç óôá åðßðåäá ãëõêüæçò óå ó÷Ýóç ôçí ðá-
ñïõóßá ìáêñï÷ñüíéùí åðéðëïêþí (éäßùò áìöéâëé-
óôñïåéäïðÜèåéá) êáé åëáôôþíïíôáò ôá åðßðåäá
ãëõêüæçò ðëÜóìáôïò ãéá ôç äéÜãíùóç ôïõ äéá-
âÞôç áðü ≥140 mg/dL óå ≥126 mg/dL. Áí êáé
õðÞñ÷áí ðñïçãïýìåíåò áíáöïñÝò ãéá ôçí áîßá
ôçò ìÝôñçóçò ôùí åðéðÝäùí HbA1c óôç äéÜãíù-
óç ôïõ óáê÷áñþäç äéáâÞôç, ç International Ex-
pert Committee, ìå ôçí ðñüóöáôç áðüöáóç ôçò,
èåùñåß ôç ìÝôñçóÞ ôçò ôüóï áêñéâÞ üóï ôá åðß-
ðåäá ãëõêüæçò óôï áßìá, ôá ïðïßá ó÷åôßæïíôáé
ìå ôçí Ýíáñîç áìöéâëçóôñïåéäïðÜèåéáò. Óå ðñü-
óöáôç áíÜëõóç, ìÝôñéá áìöéâëçóôñïåéäïðÜèåéá
ó÷åäüí äåí õößóôáôáé óå ðåñéóóüôåñïõò áðü
15.000 áóèåíåßò ìå åðßðåäá HbA1c <6.5%.
ÅéäéêÜ ãéá ôá ðáéäéÜ, ïé ïäçãßåò åßíáé ïé áêü-
ëïõèåò:
• Åðßðåäá HbA1c ≥6.5, åðéâåâáéùìÝíá ìå äåý-
ôåñç ìÝôñçóç, åßíáé äéáãíùóôéêÜ óáê÷áñþ-
äç äéáâÞôç

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ÅÐÉËÅÃÌÅÍÇ ÂÉÂËÉÏÃÑÁÖÉÊÇ ÅÍÇÌÅÑÙÓÇ

• ÌÝôñçóç HbA1c åíäåßêíõôáé óå õðïøßá óáê- Nathan DM, et al. for the International Expert Com-
÷áñþäç äéáâÞôç, üôáí ôá óõìðôþìáôá äåí mittee. International Expert Committee report on
åßíáé êëáóéêÜ Þ ôï åðßðåäï ãëõêüæçò ðëÜóìá- the role of the A1c assay in the diagnosis of diabe-
ôïò äåí åßíáé > 200 mg/dL tes. Diabetes Care, 2009; 32: 1327-1334.

Ó÷üëéï: Ç óõãêåêñéìÝíç ïäçãßá åßíáé ðïëý óçìáíôéêÞ. Óå ðáéäéÜ ìå äåßêôç ìÜæáò óþìáôïò ≥85% êáé
Üëëïõò ðáñÜãïíôåò êéíäýíïõ, ìðïñåß íá ãßíåé ìÝôñçóç åðéðÝäùí HbA1c. Ç õéïèÝôçóç ôçò óõ-
ãêåêñéìÝíçò ðñáêôéêÞò ìðïñåß íá âïçèÞóåé óôïí åíôïðéóìü ðåñéóóïôÝñùí ðáéäéþí êáé åöÞ-
âùí ìå óáê÷áñþäç äéáâÞôç, ÷ùñßò, âÝâáéá ôï ãåãïíüò áõôü íá äéáóöáëßæåé áðüëõôá ôçí
ðñüëçøç ìáêñï÷ñüíéùí åðéðëïêþí áðü ôç íüóï.
Howard Bauchner, MD
óôï Journal Watch, Pediatrics and Adolescent Medicine.
Áðü: the publishers of the New England Journal of Medicine, June 24, 2009
(http://pediatrics.jwatch.org/misc/board_about.dtl#aBauchner)

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