Оцінка хронічних запальних захворювань органів малого таза у жінок як фактора ризику виникнення гострого неускладненого пієлонефриту

Abstract

The objective: to study the prevalence of chronic inflammatory diseases of the pelvic organs (CIDPO) in women of reproductive age with acute uncomplicated pyelonephritis (AUP), and clinical peculiarities of pyelonephritis further justification for personalized therapy exposure to all sources of infection. Materials and methods. The survey was conducted by a urologist and gynecologist of 246 women of reproductive age with AUP and concomitant CIDPO. In addition, before the start of antibacterial therapy, material was collected: scrapings of the mucous membranes of the urethra, cervical canal, and vaginal washings. The complex of methods of microbiological diagnostics has been applied: cultural, culture-enzymatic, molecular-genetic. Results. In patients with AUP and concomitant CIDPO, a high rate of infections by the mollicutes was detected in urinary and genital tracts – 69.5% and 67.5%, respectively. Mollicutes were more frequently found in the urinary tract in association with classical bacteria (45.1%), and in the genital tract – in monoculture (44.7%). Importantly, in 65.8% of cases, there was a coincidence of identified pathogens by taxonomic affiliation, indicating that these pathogens are involved in the development of the inflammatory process in both the genital and urinary tracts. The proposed scheme, with the obligatory identification of pathogens of genital infections, allowed to establish that after standard urological treatment, more than two-thirds of patients require additional antibacterial therapy aimed at eradication of urinary and genital tracts of the mollicutes as pathogenic pathogens. Conclusion. The obtained results have allowed to substantiate the need for additional therapy aimed at eradication of mollicutes and to propose an algorithm of microbiological diagnostics to identify the etiological factors of AUP, to develop and implement a new approach to treatment: personalized antimicrobial therapy on all source of pathogens in the urinary and genital tracts. Key words: acute uncomplicated pyelonephritis, women of reproductive age, chronic inflammatory diseases of the pelvic organs, mollicutes, treatment.