Features of Antibacterial Therapy of Patients with Urinary Tract Infections Based on the Biological Properties of Pathogens
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Abstract
The objective: to evaluate the microbiological results of the complex etiotropic therapy in patients with acute uncomplicated pyelonephritis (АUP) and concomitant chronic inflammatory diseases of the pelvic organs (CIDPO) caused by mycoplasmas, ureaplasmas and their association with classical bacterial pathogens.
Materials and methods. We examined and treated 93 patients with AUP and concomitant CIDPO, including 34 women (group I, research) infected with classical bacteria and mollicutes, who received antibacterial therapy (ABT) in the hospital according to the protocol followed by outpatient treatment by a gynecologist according to the proposed scheme; 31 patients (group II) did not differ from the research group, but treatment of AUP was carried out only according to the protocol; 28 patients (group III) who were infected exclusively with classical bacteria were treated according to the protocol. Microbiological examination before the start of ABT using cultural, cultural-enzymatic and molecular-genetic (PCR) methods included sowing of urine, scrapings of the ureteral mucosa, cervical canal and vaginal flushings. For the research group, it was additionally proposed: doxycycline, probiotic which includes Bacillus licheniformis and Bacillus subtilis (oral and intravaginal), immunotherapy with human immunoglobulins against ureaplasmas or mycoplasmas. After 4–6 weeks after the end of treatment, a repeated microbiological diagnostics was performed.
Results. A high frequency of detecting mollicutes both in the urinary tract (69,5%) and in the genital tract (67,5%) was established, which became the basis for creating a regimen for the comprehensive etiotropic therapy of AUP and concomitant CIDPO. It was established that the treatment, both traditional and according to the proposed scheme, led to a significant decrease in the frequency of detection of classical bacteria in the urinary tract in patients of all observation groups (the maximum decrease was up to 11,8% in patients of group I). Genital tract infection with classical bacteria did not significantly change in all groups. The classical treatment for patients with AUP did not lead to a significant eradication of mollicutes from the urinary and genital tracts in patients of the comparison group II (a 16,1% decrease in infection). Only the use of the proposed treatment cheme significantly reduced the iurinary tract nfection with mollicutes by 73,6%, and genital infections by 70,6% in group I patients.
Conclusion. Conducted research have shown that after standard urological treatment, more than two-thirds of patients with AUP require additional antibiotic therapy aimed at eradicating the mollicutes as a pathogenetic link in the development and recurrence of urinary tract infections.##plugins.themes.bootstrap3.article.details##
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