Аналіз мікробного спектра у жінок з гнійно-запальними захворюваннями органів малого таза в умовах надання ургентної оперативної гінекологічної допомоги з урахуванням факторів ризику

Abstract

The objective: determination and analysis of the microbial spectrum in women with purulent-inflammatory diseases of the pelvic organs in the conditions of providing urgent surgical gynecological care, taking into account risk factors. Materials and methods. The study was conducted on the basis of City Clinical Hospital № 1 in Odessa during 2015–2019. 47 patients who underwent urgent surgical treatment for purulent-inflammatory diseases of the pelvic organs were examined. The average age of the patients was 38.3±1.5 g. Patients were in the hospital on average 10.5±0.5 days. The analysis was carried out using classical methods with the results of an antibioticogram. Results. Purulent-septic complications were observed in 18 women (38.3%). When conducting intraoperative screening of microflora isolated from abscesses, blood, purulent discharge, drainage and postoperative wounds, 30 (63.8%) patients were obtained and studied. A detailed picture was as follows: Staphylococcus epidermidis – 46.2%, E. сoli – 20.5%, Staphylococcus saprophyticus – 12.8%, Staphylococcus heholiticus – 5.1%, Micrococus – 5.1%, Enterococcus faecalis – 2.6%, Bacillus saprophyticus – 2.6%, Corynebacterium – 2.6%, Streptococcus saprophyticus – 2.6%. By combining staphylococci in one group, it was found that the proportion of Staphylococcus from the entire microflora obtained was 66%. It was found that out of 30 cases of introoperative seeding of bacterial flora, 22 women (73.32%) had a history of artificial termination of pregnancy (OR=1.93). So, in 6 patients (20.0% of the total number of microflora cases) microbial associations of various composition took place, and in 100% of cases the associations included staphylococci. Further analysis revealed a dependence on the presence of microbial association and the presence in the woman’s history of artificial abortions. So with 6 cases of intraoperative registration of microbial associations, 5 women had a history of artificial termination of pregnancy, that is, 83.0% (RR=1.67). Conclusions. 1. According to the bacteriological laboratory of City Clinical Hospital No. 1, the species composition of microflora isolated from abscesses, blood, and purulent discharge was obtained and studied in 30 patients. Thus, the bacterial culture of the total number of patients allocated in 63.8%. 2. Among pathogens of purulent-inflammatory diseases of the pelvic organs and purulent-septic complications, staphylococcus (66%), less often Escherichia coli (20.6%). 3. During the study, it was found that out of 30 patients with a bacterial culture, pathogens in the form of monocultures were isolated in 24 patients (80%), and the presence of bacterial associations was confirmed in 6 (20%) patients. Staphylococci were present in 100% of all cases of microbial associations, and E. coli in 50.0%. 4. The analysis revealed a dependence on the presence in a woman’s history of artificial abortions and registration of the microbial spectrum. So out of 30 cases of intraoperative inoculation of the bacterial flora, 22 women (73.32%) had a history of artificial termination of pregnancy (OR=1.93). And out of 6 cases of registration of microbial associations, 5 women had a history of abortion, that is, 83.0% (RR=1.67). Key words: purulent-inflammatory diseases of the pelvic organs, microbial spectrum, risk factors.