Микробиологическая характеристика хронического риносинусита у детей с муковисцидозом в сравнении с другими локусами респираторного тракта

Abstract

One of the main factors determining the severity of the course and prognosis in cystic fibrosis (CF) is the severity of the infectious and inflammatory process and the species composition of the microflora in the lower respiratory tract (LRT). Studies show the important role of the nasal cavity and paranasal sinuses as a source and reservoir of microflora. Objective. To assess the species composition and correlation of microflora from the various parts of the upper and lower respiratory tract in children with cystic fibrosis. Patients and methods. 94 patients aged 2 to 18 years diagnosed with chronic rhinosinusitis with cystic fibrosis which had surgical intervention were included. The species composition of microflora was obtained from paranasal sinuses and nasal cavity, evaluated intraoperatively, from trachea during intubation in comparison with the actual (1-3 weeks before the intervention ) results of bacteriological test of induced sputum and / or material from the posterior pharyngeal wall, as well as the most "clinically significant" microflora in the anamnesis. Statistical analysis was carried out in order to search for correlations of the species composition of the bacterial flora between these parts of the respiratory tract. Results. The analysis showed no correlation between the microflora of different parts, except for the correlation between the most "clinically significant" microflora in anamnesis and obtained intraoperatively from paranasal sinuses in relation to two prognostically unfavorable species of bacteria: Sternotrophomonas maltophilia ( p = 0.001) and Pseudomonas aeruginosa (p = 0.047). In 13 (81.3%) of the 16 patients which had in anamnesis P. aeruginosa and was isolated from the maxillary sinus intraoperatively, its eradication was ascertained. Conclusion. The revealed positive correlation between the isolation of P. aeruginosa ever in anamnesis from low respiratory tract (LRT) and its presence in the paranasal sinuses during intraoperative sampling of the material indicates the important role of paranasal sinuses as a reservoir of pathogenic microflora and the possibility of long-term preservation of infectious agents after eradication courses of treatment and the achievement of eradication. Keywords: cystic fibrosis, children, chronic rhinosinusitis, microflora, Pseudomonas aeruginosa, paranasal sinuses