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DOI: http://dx.doi.org/10.20534/ESR-17-5.6-28-30
Muminova Nigora Khayritdinovna, The senior lecturer of faculty of Obstetrics and gynecology of Tashkent Institute of improvement of doctors Karimova Feruza Djavdatovna, Professor of the Department of Obstetrics and Gynecology of the Tashkent Institute of improvement of doctors Zakhidova Kamola Shukhatovna, Doctor of Family policlinik № 46 of Tashkent E-mail: nigora-1967@inbox.ru
THE ROLE OF MIXED BACTERIAL INFECTION IN PURULENT-SEPTIC DISEASES
Abstract: Bacterial vaginosis can provoke serious gynecological and obstetric complications both during pregnancy and outside it. Pre-gravity training, which includes the treatment of bacterial vaginosis with a mixed infection, significantly reduces the incidence of purulent-septic complications in childbirth and in the postpartum period. Keywords: Bacterial infection, candidiasis, sepsis, miconazole.
Relevnce: The vagina is a complex self-regulating ecosystem that creates its own environment and maintains a balance between normal microflora and opportunistic microorganisms. With bacterial vaginosis, the number of lactobacilli sharply decreases, giving way to pathogenic flora [1; 5].
Normal vaginal microflora in turn help s suppress the growth of many potential pathogens and is one of the conditions for maintaining colonization resistance, the violation of which entails the risk of a number of pathological conditions and diseases, including during pregnancy and in the period of growth of purulent-septic complications [3; 4].
It should be noted that the choice of tactics for managing patients with bacterial vaginosis is sometimes difficult due to frequent relapses of the disease. The task of drug therapy for bacterial vaginosis has several goals: restoring the diseased balance of the vaginal microflora, suppressing the opportunistic flora (mainly anaerobic), preventing fungal superinfection. In this case, treatment should not affect the epithelium of the vagina — a pledge to restore normal microflora. In addition, it must be remembered that bacterial and fungal infections are often mixed, so a wide range of drugs should be used, with antibacterial, antiprotozoal and fungicidal effects [2; 6].
Objective: Was to identify the dependence of the course of pregnancy and childbirth on the state of the vaginal biocenosis of pregnant women.
Material and research.We conducted a retrospective analysis of the history of delivery of 165 women, which were divided into 2 groups. In 1 group included 93 pregnant women with uncomplicated course of the postpartum period. 72 patients with high infectious risk were assigned to group 2. A retrospective analysis of the history of labor showed that the outcomes of pregnancy in group 2 were as follows: 39 premature births in terms of 29-37 weeks, 33 urgent deliveries in terms of 38-40 weeks.
The age of patients in the two study groups ranged from 17 to 29 (mean age-21.8 ± 1.3 years). The duration of the disease is from
2 to 4 days. Menarche was approximately the same in the two groups and was: 12.8 ± 1.6 years and 12.6 ± 2.3 years, respectively. The age of onset of sexual activity also had no difference in the control and main group (p > 0.05) and averaged 22.7 ± 4.1 and 21.6 ± 3.4, respectively.
Based on anamnesis, the outcome of previous pregnancies is studied. In the main group, obstetric complications such as undeveloped pregnancy in 21 (29.1%), spontaneous abortions in terms of 4-16 weeks — 39 (54.1%), the threat of miscarriage was from 72 in 63 (87.5%), Urinary tract infection (UTI) in 47 (65.3%), premature rupture of membranes in 49 (68%), premature delivery in terms of up to 34 weeks in 28 (38.9%), before 37 weeks in 31 (54, 1%); In labor, the frequency of the abnormality of labor was in two groups identical; A manual examination for the delay of the placenta in 24 (33.3%), hypotension of the uterus in 16 (22.2); In the postpartum period: syndrome of the systemic inflammatory response (SIRS) in 12 (16.7%), endometritis in 13 (18%), infection of the sutures and wound healing by secondary tension in 15 (20.8%), UTI in 14 (19, 4) women. In the 1-group, the listed complications were 3 times less common;
As a result of the above complications, various invasive interventions with instrumental studies were conducted by women, which could also provoke the appearance of purulent-septic conditions, often in the penetration of anaerobic infection into the body.
Extragenital factors also played an important role: anemia of 2 and 3 degrees in 49 puerperas from 72 women of the 2nd group, presence of UTI in 29, recurrent or transferred during pregnancy bacterial vaginosis in 45 or more patients.
An investigation of the incidence of infectious-inflammatory pathology of the birth canal showed that the infectious and inflammatory process in the birth canal of a specific and nonspecific etiology was found only in the group of pregnant women of high infectious risk with an unfavorable outcome of pregnancy (89). For example, Nonspecific vulvovaginitis was detected in the third trimester in 43 cases (31.39%), of which bacterial vaginosis accounted for more
THE ROLE OF MIXED BACTERIAL INFECTION IN PURULENT-SEPTIC DISEASES
than 75% of sexually transmitted infections in 20 patients (14.6%) sexually transmitted infections in 20 patients (14.6%).
Statistical analysis showed that a favorable outcome ofpregnancy in a significant percentage of cases is accompanied by normocenosis of the antenatal tracts of the pregnant woman — in 29%. In 2 group normocenosis was not recorded in any pregnant woman.
To verify the pathogen, the results of a bacterioscopic and bacteriological analysis of the microenvironment of the genitals (where the Candida fungi were sown 60%, including C. Albisans and tropi-calis, and 40% of cases Trichomonus vaginalis and Gardnerella.
A comparison of the incidence of bacterial vaginosis showed that a significant difference in the incidence of bacterial vaginosis in both groups was: in 1 group, in 26 patients, in 15 patients, and in 24 for 34 women, 24.8%.
Similar results were obtained when analyzing the incidence of vulvovaginal candidiasis in 18 examined pregnant women (19.4%) and 26 (18.98%) in two groups, respectively.
Results of the study
Based on the study, we can conclude that the infectious and inflammatory pathology of the prenatal pathway of a pregnant woman is a risk factor for intrauterine infection and the development of adverse complications for the pregnant and fetus, and subsequently for the newborn.
To prevent the expected complications, in advance to all 72 gynecological patients with bacterial infection and sexually transmitted infections (STI) having a high infectious risk of the birth canal, a pregravidated complex antibacterial therapy with the inclusion of miconazole was carried out.
Studies have proven that myconazole has an selective bactericidal effect against those microorganisms whose enzyme systems are capable of reducing the nitro group. Active reconstituted forms of the drug disrupt Deoxyribonucleic acid (DBA) replication and protein synthesis in the microbe cell, inhibit tissue respiration. It is an antifungal and anti-inflammatory synthetic drug widely used in gynecology. The active substance of the drug — miconazole nitrate, has antifungal and antibacterial action against: Candida albicans of different species, Microsporum canis; Aspergillus niger, as well as against staphylococci and streptococci and less pronounced for Pseudomonas aeruginosa, Escherichia coli, Proteus, and others. With topical application, miconazole is practically not absorbed into the systemic circulation and is highly effective in the local treatment of mixed infections caused by Candida and gram-positive flora. The drug during pregnancy because of the lack of systemic actions was applied intra-vaginally after the first trimester, as only 1.4% of the dose is absorbed into the blood.
The drug Mikotran 1200 gynecological patients was prescribed in candles before bedtime 1 time and in cases of chronic and persistent vaginosis and candidiasis dose repeated after 3 days.
Women received a course of therapy in a polyclinic or at home under the regular supervision of a specialist. After the end of the course of therapy, all patients submitted tests for the presence of pathogens during 2-3 menstrual cycles, with chronic vaginal candidiasis, and they were more than 50%, on the 5th-6th day of the menstrual cycle (immediately after menstrual cycles), treatment Repeated 3-6 months in a row.
When choosing miconazole, we took into account its high activity with a wide spectrum, its biological and economic availability with minimal side effects.
The advantages of Mikotran for complex treatment was: the lack of systemic effects on the body; Minimal risk of adverse reactions; Simplicity and convenience of use (minimum one-time reception per day); Absence of contraindications (except for individual intolerance of the drug and during pregnancy during the 1st trimester); The possibility of using in patients with extragenital pathology (especially in the localized forms of the infectious process, such as acute vulvitis, vaginitis, cervicitis or exacerbation of chronic vaginal or cervical processes), rapid entry into the focus of infection and rapid action (3.5) and of no small importance Place, that the drug is economically available and the results of the studies have proved that its quality is not inferior to any other drugs possessing the same properties.
The effectiveness of therapy was assessed by the following indicators: the general condition and well-being of patients; Clinical data (history and gynecological examination data), laboratory bac-terioscopy data.
Results of the examination and treatment showed a general improvement in the condition and relief of symptoms inflammation was observed from 72 women in 66 (91.7%) patients within 2-3 days after the end of the course of therapy. The change in the clinical picture and subjective sensations (change in the nature of discharge, reduction of irritation, itching, burning) is noted. According to the gynecological examination, the patients had a better vaginal mucosa (decreased puffiness and hyperemia). Positive bacteriological effect of the drug was noted — in 61 (84.7%) suppression of pathogenic microflora, including anaerobic flora (according to bacterioscopy) was detected. Adverse reactions against the background of therapy with the drug Mikotran are not noted in any case.
Thus, high efficacy, lack of systemic effect on the body, and also available use make it possible to consider a complex action drug, in particular myconosol nitrate (Mikotran), an effective and acceptable means for treating mixed infections in both the lower part and the upper genital tract.
We also evaluated the effectiveness of therapy with Mycotrana, with the pregravid preparation of women with mixed infection and STIs, in order to avoid the attachment of bacterial vaginosis. The long-term results of the study showed that in the group of 72 women the pre-schooled cases of gynecological complications in the form of an undeveloped pregnancy-6 (8.3%), spontaneous miscarriages-7 (9.7%) decreased by 5-6 times, the threat of miscarriage in the early stages - 12 (16,7%) to 5 times, UTI-23 (31,9%) almost 2 times, premature births in terms of up to 34 weeks (11,1%) - 3,5 times, up to 37 weeks - 3-fold, postpartum complication: manual examination of the uterine cavity for the delay of the placenta and its fragments in 6 (8.3%); SIRS-4 (5.5%) and endometritis and infection of postoperative sutures in 5 (6.9%) is a decrease of 3.5 times with cases when women with mixed infection did not undergo pre-education training.
Clinico-laboratory data indicate that the efficacy of Mikotran therapy has been as high as 95% under these conditions.
Conclusion: Pre-birth training of women with mixed infection and STI is necessary to prevent complications such as spontaneous abortions, the threat of abortion, undeveloped pregnancy, premature birth, UTI, postpartum-invasive interventions such as manual examination of the uterine cavity, infection ofpostoperative sutures, SIRS, metroendometritises, cases of UTI occurring during pregnancy and in the postpartum period, effective treatment of which decreases from 3 to 5-7 times higher than the transcript Complication [2; 4].
Due to the combined antimycotic and antibacterial effect of mykonosal nitrate in the composition of Mikotran, which has high clinical efficacy in genital infections and bacterial vaginosis, it increases the compliance of treatment, reduces the number of side effects, quickly corrects symptoms (discharge, itching), gives a pronounced clinical effect, confirmed by the results of microbiological studies, which also contribute to the reduction of perinatal mortality, as well as maternal and child morbidity [5; 6].
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