ПРОТИВОМИКРОБНАЯ ТЕРАПИЯ ПРИ РИНОСИНУСОГЕННЫХ ОСЛОЖНЕНИЯХ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА

Abstract

Rhinosinusogenic orbital (RSOC) and intracranial complications (RSIC) remain relevant for physicians of various specialties due to high risks of unfavorable outcomes. The key to successful medical care of patients with complicated forms of nasal and paranasal sinus pathology is not only untimely diagnosis and surgical sanation of the primary focus of infection, but also properly selected systemic antimicrobial therapy (SPMT), the choice of which is based on local data on the structure of pathogens and their sensitivity to antibacterial drugs. As a result of retrospective analysis of medical records of 266 completed cases of complicated forms of rhinosinusitis in adult patients for the period from 2010 to 2023, the peculiarities of the course of RSOC and RSIC, the microbial landscape in this pathology, the nature and extent of SPMT were studied. It was revealed that in the structure of the complicated course of RSOC occupy the leading positions. Secondary meningitis prevailed among RSIC, accounting for (92.6%). Clearly expressed changes of inflammatory character on the part of the general blood analysis and integral hematologic indices were characteristic for RSIC and purulent-inflammatory complications of the eyes. Staphylococcus spp. prevailed in the structure of etiologic factors in RSOC, while polymorphism of the isolated microflora was observed in RSIC (Staphylococcus spp., Streptococcus spp., Enterobacterales, Acinetobacter spp., Enterococcus spp., anaerobes, Candida spp., Mucor spp). Analysis of antibiograms revealed that the most problematic in terms of the choice of SPMT were representatives of the order Enterobacterales, Acinetobacter spp., in some established ones - Enterococcus spp., among the pathogens of mycosis - Mucor spp. 3-generation cephalosporins prevailed in the structure of empirical SPMT, and to a lesser extent inhibitor-protected aminopenicillins. However, the severity of the patients' condition, especially in case of RSIC, the results of microbiologic examination dictated the need to switch to "observation" antibiotics (meropenem, cefepime). Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT led to favorable outcomes in 98.8% of patients.