МИКРОБИОЛОГИЧЕСКИЕ АСПЕКТЫ ЭТИОЛОГИИ ОСТЕОМИЕЛИТА ЧЕЛЮСТЕЙ

Abstract

Background. Difficulties in the treatment of the inflammatory process of bone tissue focus the attention of researchers and practitioners on the early identification of pathogens of osteomyelitis, which is the key to successful treatment of the disease. According to publications cited in The Cocrane Library database, the epidemiology and etiological structure of osteomyelitis has undergone significant changes in recent years. 
 The aim of the review is to provide up-to-date information on etiologically significant representatives of the microbial flora in osteomyelitis of the jaws. Methodology. Search work was carried out using international scientific databases PubMed, ScienceDirect, Scopus, Cochrane Collaboration, Elsevier, as well as electronic catalogs Elibrary and Cyberleninka on microbiological aspects of the etiology of osteomyelitis of the jaws. 
 Results. A review of publications has demonstrated the dominant position of representatives of the genus Staphylococcus in the etiological spectrum of chronic post-traumatic osteomyelitis. The predominant pathogen is S. aureus. The proportion of infections mediated by S. epidermidis, S. Saprophyticus is, on average, about 25% of cases. The proportion of representatives of the gram-negative flora Escherichia, Klebsiella, Enterobacter, Citrobacter, Proteus, Providencia, Serratia reaches 23% of cases. According to the above information, the causative agents of gram-negative infections make up 1/5 of the etiological spectrum of chronic osteomyelitis. Pathogenic nosocomial strains of P. aeruginosa are also involved in the formation of chronic inflammation in osteomyelitis. According to the results of published studies, more than a third of cases of chronic osteomyelitis are mediated by microbial associations. The latter are dominated by S. aureus, S. epidermidis and, less frequently, E. faecalis. At the same time, dynamic analysis showed the variability of the microbial composition of associations, which determines additional difficulties in choosing the actual etiotropic therapy and may cause further progression of the pathological process. 
 Conclusions. Implementation of effective methods of therapy requires new informative diagnostic approaches. However, the sensitivity of routine microbiological analyzes is not high enough. At the present stage, the diagnostic value of molecular genetic methods based on the polymerase chain reaction has been recognized.