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COMPARATIVE STUDY OF СROPPING ABILITY OF ETIOLOGICAL AGENTS OF THE CHILD CHRONIC PURULENT GAIMORITES
Tairova Sevara Furqatovna, Tashkent Medical Academy E-mail: dildor-22@bk.ru
COMPARATIVE STUDY OF OROPPING ABILITY OF ETIOLOGICAL AGENTS OF THE CHILD CHRONIC PURULENT GAIMORITES
Abstract: The aim of the study was to assess the etiological structure of chronic purulent and acute sinusitis at children as the patients in the dynamic of the decease. It was found that the gram-negative flora was dominated by the chronic purulent maxillary sinusitis, while the gram-positive microflora prevailed as result of the acute purulent maxillary sinusitis. In addition, the spectrum of pathogens in the case of chronic sinusitis was significantly greater than in the case of acute sinusitis. The indexes of dynamicof the bacterial inflammation characterized by fractionally changing of the pathogen's species composition in the postoperative cavity in both compared groups: chronic and acute. It was found, a low sensitivity of strains: S. aureus, S.viridans, S.epidermidis to the unprotected penicillin, however, the higher sensitivity was discovered for the cephalosporin of different generations.
Keywords: the sick children, the chronic purulent sinusitis, the pathogens, identification, antibiotic resistance.
It is known that nowadays for the clinical microbiology it was in- and species identification of cultures were based on their deter-
creased the diagnostic importance of the bacteriological examinations of ENT organ's diseases (i. e., the paranasal sinuses) [4].
It was revealed sinusitis agents more often were: S. sinusitis S. pneumoniae (48.0%) and H.influenza (12.0%), and more rarely observed anaerobes: S.pyogenes, M.catarrhalis, S.aureus, [2; 5]. In the case of the recurrent acute sinusitis, the spectrum of pathogens did not differ from the spectrum of acute sinusitis. The authors affirmed that amplification of chronic sinusitis was generally due to anaerobic agents.
The actuality of the study consist in firmly increased pathogen's resistance of the inflammatory agents of paranasal sinuses to antibacterial preparates, infast changing of pathogen's landscape, in enlarged importance the anaerobes into pathogenesis of chronic etiology of paranasal sinuses [3; 6; 8].
In the study we are aiming to investigate and evaluate the dynamic of etiological structure of the chronic purulent and acute sinusitis for children.
Materials and methods.For this goal the 130 sick children under 15 years old were studied. The examined patients were boys -69 (53.1 ± 4.4%) and girls - 61 (46.9 ± 4.4%). Among these were children rural area - 98 (75.4 ± 3.8%) and 32 (24.6 ± 3.8%) patients were urban area. The patient's distribution by age was as followings: from 0 to 6 years - 39 (30.0 ± 4.0%) and from 7 to 15 years - 91 (70.0 ± 4.0%) of children.These patients were divided into 2 representative groups: the first principalgroup - 95 children with chronic purulent sinusitis (ChPS); and the second comparison group -35 children with acute sinusitis (AS).The studyweredone in dynamic: before surgery, and at 3, 7 and 14 day after surgery.
The all patients were diagnosed with help the clinical, instrumental, bacteriological methods according to Statistical Classification of Diseases and Related Health Problems (2007).
Collection of the biological material (i. e. pus from pathological focus) and delivery of samples to bacteriological laboratory was carried out according with the traditional method.Identification and differentiation of pathogens were carried out in concordance with Bergey'sManual Systematic Bacteriology [1]. Sowing of the material was carried out according to Gold 'manual book. Genus
mination of main taxonomic features. To etiologically significant were considered the pathogens cropped at concentration on nutrient media of HiMedia (India) more than 10 4-10 5 CFU/ml.To determine resistance of the cultures against antibiotics, the discdiffusion method was used [7]. The method is based on diffusion the antibacterial drug throughthe paper disc into the tough nutrient medium (Muller-Hinton), and onsuppressing ofculture growth at concentration of 1.5 x 10 8 CFU/ml in zone where concentration of the antibacterial drug is exceeded the minimum inhibitory concentration. The density of inoculum (suspension of studied microorganisms) was adjusted to 0.5 according with McFarland (i. e. with turbidity standard) and used in the period of15 minutes after the preparation.Petri dishes were filled withagar layer of 4 mm thick (Petri dish of diameter 90 mm filled with 20 ml of agar) and were used immediately. Standard inoculum consisted of 2 ml the nutrient medium pipetted into Petri dishes.Standardized commercial disks of HiMedia (India) were used. The glasses with the disc pulled out refrigerator before 1 hour of start. The sensitive (S), conditioned-resistant (SR), resistant (R) strains were evaluated on measuring of their growth diameter [7].
To evaluate results of the study was taken into account the qualitative and quantitative composition of natural microflora of the clinical samples. As etiologically significant were assumed: a) the detection of microorganisms are not belonging to natural microflora (i. e. microflora of the upper respiratory tract), or b) detection of unusually large number of microorganisms of any species.
The more difficult it was interpretation of results for chronic inflammatory processes, in the case of detection of microorganism's association. Growth ofvarious species from the associations was quantified as initial sowing of pathological material on nutrient media. The species are quantitatively predominated, was taken the leading position in the etiology of the disease. Interpretation of results on the contents of maxillary sinus usually was not difficult, since detected microorganisms were the causative agents of studied disease.
Statistic analyses carried out using the method of variation statistics with help programs for biomedical research. Experiments based on the evidence-based medicine principles.
Section 3. Medical science
Results and discussion. It was noted for the 6,9 ± 2,2% (n = 9) of sick patients a result marked as "negative bacteriological result", and for 93,1 ± 2,2% (n = 121) of patients result marked as "positive bacteriological result". Due to study it was emphasized that "monoculture"of microorganisms was obtained for 33,1 ± 4,3% (n = 40) ofpatients, and "associationofmicroorganisms for 66,9 ± 4,3% patients (n = 81; mainly 2-3 pathogens).
Cropping of the etiological agents before surgery from thechild'biological materials with chronic and acute sinusitis (n = 121) shown in Figure: S.viridans - 21.5 ± 3.7% (n = 26), S.aureus - 19, 0 ± ± 3.6% (n = 23), S.epidermidis 16.5 ± 3.4% (n = 20), P. aeruginosa -15.7 ± 3.3% (n = 19), E. coli - 13.2 ± 3.1% (n = 16), Enterococcusspp 5.8 ± 2.1% (n=7), Proteusspp 5.0 ± 2.0% (n = 6), S.haemoliticus - 1.7 ± ± 1.2% (n = 2), S.saprophyticus - 1.7 ± 1.2% (n = 2).
Figure1. The etiologic structure of sinusitis agents (acute and chronic) of child before medical treatment,%
For chronic sinusitis patients in 88 out of 95 cases and for acute sinusitis patients in 33 out of 35 cases, the "positive bacteriological results" were obtained. The microbial landscape of chronic sinusitis patients (n = 88) was mainly represented by strains: P. aeruginosa (19.3 ± 4.2%, n = 17), E. coli (13.6 ± 3.7%, n = 12), S.aureus (11.4 ± ± 3.4%, n = 10), S.viridans (10.2 ± 3.2%, n = 9), S.epidermidis (10.2 ± ± 3.2%, n = 9), etc. For chronic sinusitis patients, in contrastwith acute sinusitis patients (comparison group), the gram-positive microflora was prevailed and pathogen's spectrum was significantly less (P < 0.05).
It was found, that indexes of the bacterial contamination in dynamic characterized by fractional changing of pathogen's species composition in the postoperative cavity in both compared groups (chronic and acute). It was revealed, the before surgery was only observed 7 patients (7.3 ± 2.7%) with chronic and 2 patients (5.7 ± 3.9%) with acute sinusitis marked as "negative bacteriological result", but at the third day after surgery the indexes was raised to 43.1 ± 5.1% (n=41) and to 40.0 ± 8.3% (n = 14), respectively for chronic and acute patients. This result indicated the successful medical treatments of both chronic and acute groups.
When we have compared the inoculation rate of S. aureus for chronic sinusitis in dynamics: before surgery it was 11.4 ± 3.4% (n = 10), and after surgery: on the third day - 13.6 ± 3.7% (n = 12), on the seventh day - 11,4± 3,4% (n = 10) and on the 14 th day - 9,1 ± ± 3,1% (n = 8). For acute sinusitis inoculation rate of S. aureus, were obtained the following indexes: before surgery - 39.3 ± 8.5% (n = 13), after surgery: on the third day - 24.2 ± 7.5% (n = 8), on the 7 th day -21.2 ± 7.1% (n = 7) and on the 14 th day -12.1 ± 5.7% (n = 4).
Comparative analysis indicated that in the first group of children, there was no significant difference between the indexes in its
dynamic (P > 0.05), while for second group there was statistically significant difference (P <0.05).
The seeding rate of S.viridans in the "chronic" group was practically the same as the germination rate of S. aureus, while for children with acute sinusitis, the seeding rate of S. aureus (P <0.05) was significantly more pronounced.
The similar results were obtained for patients with on the seeding rate of S. epidermidis. We had not found any specific pattern for this index, and the post-surgery seeding rates were not bearing a definite tendency to decreasing/increasing (P > 0.05).
The study of sensitivity of the pathogen's seeded strains to the antibacterial drugs, it was found the median sensitivity of strains: S.aureus, S.viridans, S.epidermidis to unprotected penicillin (n = 69; S = 17.4 ± 4.6%, n = 12), but the higher sensitivity was established for the cephalosporin of different generations: from S = 76.8 ± 5.1% (n = 53) to S = 95.7 ± 2.4% (n = 66). All strains of the mentioned pathogens (S = 100%, n = 69) were high sensitive to amoxiclav.
The study resulted that the coagulase-negative staphylococci have not influenced definitely on maintenance of the acute inflammatory process, while the species S.aureus played the main role at the process. In other hand, at the chronic inflammatory process, was not observed the significant differences between the coagulase-negative staphylococci and S. aureus (P > 0.05).
It is interesting that for children of "main" group (n = 95) the inoculation processes on 14 th day after surgery demonstrated only the normal representative microflora of the upper respiratory tract in 29.5 ± 4.7% cases (n = 28), though this trend was not observed for children of "comparison" group.
COMPARATIVE STUDY OF ŒOPPING ABILITY OF ETIOLOGICAL AGENTS OF THE CHILD CHRONIC PURULENT GAIMORITES
Conclusions
1. For 93.1% of the studied patientsit was found the "positive bacteriological result", and for 33.1% of patients, their results was obtained as monoculture, for 66.9% of patient as association of microorganisms (i. e., 2-3 pathogens).
2. Before the beginning of medical treatment, the child patients with acute and chronic sinusitis, were inoculated by: S.viridans (21.5%), S.aureus (19.0%), S.epidermidis (16.5%), P.aeruginosa (15.7%), E.coli (13, 2%), Enterococcus spp (5.8%), Proteus spp (5.0%), S.haemoliticus (1.7%) and S.saprophyticus (1.7%).
3. Among the children patients with chronic sinusitis, was predominated thegram-negative, while among the children with acute sinusitis dominated fauna was the gram-positive.In addition, the spectrum of pathogens for chronic patientswas significantly greater.
4. The indexes of dynamic of the bacterial inflammation characterized by fractionally changing of the pathogen's species composition in the postoperative cavity in both compared groups. It was revealed that before surgery only 7.3% ofchronic sinusitis patients and 5.7% of acute sinusitis patient shown the result that was marked as "negative bacteriological result". However, on the third day after surgery, the indexes were risingin at both groups - 43.1% and 40.0% respectively for chronic and acute patients. This fact indicated about the successful medical treatments of both groups of child.
5. It was noted the low sensitivity of strains: S. aureus, S.viridans, S.epidermidis to the unprotected penicillin, but the higher sensitivity to cephalosporin of different generations. All of pathogen's strains were sensitive to amoxiclav.
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