Microbial flora in patients with bronchopulmonary pathology
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2025
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| author | Boyko, Valery Tkachenko, Vladimir Kritsak, Vasyl Sochnieva, Anastasiya Minukhin, Dmytro Yevtushenko, Denys Ponomaryov, Volodymyr Ponomarova, Valeriia |
| author_facet | Boyko, Valery Tkachenko, Vladimir Kritsak, Vasyl Sochnieva, Anastasiya Minukhin, Dmytro Yevtushenko, Denys Ponomaryov, Volodymyr Ponomarova, Valeriia |
| contents | <p><strong><span lang="EN-US">Introduction</span></strong><span lang="EN-US">. The study of microbial pathogens of acute purulent-destructive diseases of the lungs and pleura significantly affects the further course of the disease and the outcome of treatment. The appointment of antibacterial drugs taking into account the sensitivity to the microbial pathogen has a significant advantage compared to broad-spectrum antibacterial therapy. The purpose of this study: to characterize the microbial spectrum and antibacterial sensitivity of isolates isolated from pleural fluid, bronchial washings, sputum and purulent cavity punctates in patients with bronchopulmonary pathology and to assess the proportion of anaerobic and polymicrobial infections to provide recommendations for improving the therapy of patients with purulent-destructive diseases of the lungs and pleura. </span><strong><span lang="EN-US">Materials and methods.</span></strong><span lang="EN-US"> The results of microbiological studies of washes of the tracheobronchial tree and pleural cavity in 500 patients with bronchopulmonary pathology for the period 2008-2024 were analyzed. This section of the study was completed by patients who made up the conditional control (238 patients (47.6%) and the main group (262 patients (52.4%) of the study. To determine the level of bacterial contamination of the pleural cavity, a microbiological study of the effusion was performed according to standard methods upon admission of the patient to the hospital, after surgery on the 1st, 3rd, and 5th day. For materials from purulent cavities (abscesses, empyemas), a qualitative inoculation of 0.04 ml of culture was used due to the high load of pathogens. Microbiological studies in materials from purulent cavities and interpretation of the results together with the clinical picture were performed in accordance with international guidelines. Cultivation of the study bacteria was carried out in traditional nutrient media: nutrient agar (Biolife, Italy), Endo medium (HiMedia, India), blood and yolk-salt agars, Sabouraud agar with glucose (Farmaktiv LLC, Ukraine), modified thioglycolic medium and Kitta-Tarozzi medium, incubation conditions were standard at a temperature of 35 - 37 °C for 24 - 48 hours. Identification of isolated cultures and sensitivity of cultures of microorganisms to antibiotics were carried out according to generally accepted methods. The results were interpreted according to EUCAST. </span><strong><span lang="EN-US">Results</span></strong><span lang="EN-US">. This study provided an idea of the significance of the spectrum of microbial flora of bronchial and pleural washings in patients with bronchopulmonary pathology in different periods of its complex treatment. In most patients, associations with 2 - 3 types of bacteria were detected, and the number of pathogens statistically significantly increased (p < 0.05) according to the severity of the clinical form (abscess - gangrenous abscess - gangrene). This indicates about the important role of microbial synergy in the formation of lung tissue destruction. Anaerobic microorganisms were isolated in a significant proportion of patients with purulent-necrotic destruction of the lungs and pleura. They were detected in 78.1% of cases: in 28.9% as a monoinfection and 49.2% in associations with aerobes. The contents of purulent cavities had the highest frequency of anaerobes (51.6%). This indicates a possible etiological role of anaerobic microorganisms in the infectious process and the prospect of involving targeted anaerobic culture in such patients. Anaerobic bacteria were not detected in sputum, and in bronchial washings and punctates of purulent cavities they were isolated from 26.7% to 51.6%, which indicates the need to use invasive materials (bronchial washings, punctates, pleural exudates) for accurate diagnosis. It is established statistically significant isolation of Streptococcus spp., Enterobacteriaceae, Pseudomonas spp. and anaerobic microorganisms (p < 0.05), which confirms the etiological role of these pathogens in pulmonary-pleural pathologies. Almost all representatives of the Enterobacteriaceae family, bacteria of the genus Streptococcus sp. and Staphylococcus sp. were sensitive to carbapenems. Among Pseudomonas aeruginosa and bacteria of the genus Enterococcus sp., multiresistant strains were most often encountered. The feasibility of using de-escalation antibacterial therapy has been confirmed. Antibacterial therapy in the de-escalation mode is prescribed to the patient for 7 days. The drugs are administered intramuscularly or intravenously, since the capillary blood flow through the pulmonary artery system is blocked in the absence of destruction of the lung tissue. The main antibacterial drugs in this case are thienames, meronem, amoxiclav. After receiving the results of the bacteriological study, the antibacterial drug is changed, taking into account sensitivity of this flora, followed by therapy for 7 days. </span><strong><span lang="EN-US">Conclusions</span></strong><span lang="EN-US">. Studies of microbial flora in patients with bronchopleural diseases reflect specific pathological pathways and can become an important tool for making clinical decisions when managing this complex cohort of patients. The results obtained have practical significance for clinicians: the obtained spectrum of pathogens and established antibiotic sensitivity allow optimizing empirical therapy, reducing the risk of inadequate treatment and improving the prognosis in patients with severe pulmonary-pleural infections.</span></p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_17923418 |
| institution | Zenodo |
| language | ukr |
| publishDate | 2025 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | Microbial flora in patients with bronchopulmonary pathology Boyko, Valery Tkachenko, Vladimir Kritsak, Vasyl Sochnieva, Anastasiya Minukhin, Dmytro Yevtushenko, Denys Ponomaryov, Volodymyr Ponomarova, Valeriia bronchopleural diseases microbial flora antibacterial therapy <p><strong><span lang="EN-US">Introduction</span></strong><span lang="EN-US">. The study of microbial pathogens of acute purulent-destructive diseases of the lungs and pleura significantly affects the further course of the disease and the outcome of treatment. The appointment of antibacterial drugs taking into account the sensitivity to the microbial pathogen has a significant advantage compared to broad-spectrum antibacterial therapy. The purpose of this study: to characterize the microbial spectrum and antibacterial sensitivity of isolates isolated from pleural fluid, bronchial washings, sputum and purulent cavity punctates in patients with bronchopulmonary pathology and to assess the proportion of anaerobic and polymicrobial infections to provide recommendations for improving the therapy of patients with purulent-destructive diseases of the lungs and pleura. </span><strong><span lang="EN-US">Materials and methods.</span></strong><span lang="EN-US"> The results of microbiological studies of washes of the tracheobronchial tree and pleural cavity in 500 patients with bronchopulmonary pathology for the period 2008-2024 were analyzed. This section of the study was completed by patients who made up the conditional control (238 patients (47.6%) and the main group (262 patients (52.4%) of the study. To determine the level of bacterial contamination of the pleural cavity, a microbiological study of the effusion was performed according to standard methods upon admission of the patient to the hospital, after surgery on the 1st, 3rd, and 5th day. For materials from purulent cavities (abscesses, empyemas), a qualitative inoculation of 0.04 ml of culture was used due to the high load of pathogens. Microbiological studies in materials from purulent cavities and interpretation of the results together with the clinical picture were performed in accordance with international guidelines. Cultivation of the study bacteria was carried out in traditional nutrient media: nutrient agar (Biolife, Italy), Endo medium (HiMedia, India), blood and yolk-salt agars, Sabouraud agar with glucose (Farmaktiv LLC, Ukraine), modified thioglycolic medium and Kitta-Tarozzi medium, incubation conditions were standard at a temperature of 35 - 37 °C for 24 - 48 hours. Identification of isolated cultures and sensitivity of cultures of microorganisms to antibiotics were carried out according to generally accepted methods. The results were interpreted according to EUCAST. </span><strong><span lang="EN-US">Results</span></strong><span lang="EN-US">. This study provided an idea of the significance of the spectrum of microbial flora of bronchial and pleural washings in patients with bronchopulmonary pathology in different periods of its complex treatment. In most patients, associations with 2 - 3 types of bacteria were detected, and the number of pathogens statistically significantly increased (p < 0.05) according to the severity of the clinical form (abscess - gangrenous abscess - gangrene). This indicates about the important role of microbial synergy in the formation of lung tissue destruction. Anaerobic microorganisms were isolated in a significant proportion of patients with purulent-necrotic destruction of the lungs and pleura. They were detected in 78.1% of cases: in 28.9% as a monoinfection and 49.2% in associations with aerobes. The contents of purulent cavities had the highest frequency of anaerobes (51.6%). This indicates a possible etiological role of anaerobic microorganisms in the infectious process and the prospect of involving targeted anaerobic culture in such patients. Anaerobic bacteria were not detected in sputum, and in bronchial washings and punctates of purulent cavities they were isolated from 26.7% to 51.6%, which indicates the need to use invasive materials (bronchial washings, punctates, pleural exudates) for accurate diagnosis. It is established statistically significant isolation of Streptococcus spp., Enterobacteriaceae, Pseudomonas spp. and anaerobic microorganisms (p < 0.05), which confirms the etiological role of these pathogens in pulmonary-pleural pathologies. Almost all representatives of the Enterobacteriaceae family, bacteria of the genus Streptococcus sp. and Staphylococcus sp. were sensitive to carbapenems. Among Pseudomonas aeruginosa and bacteria of the genus Enterococcus sp., multiresistant strains were most often encountered. The feasibility of using de-escalation antibacterial therapy has been confirmed. Antibacterial therapy in the de-escalation mode is prescribed to the patient for 7 days. The drugs are administered intramuscularly or intravenously, since the capillary blood flow through the pulmonary artery system is blocked in the absence of destruction of the lung tissue. The main antibacterial drugs in this case are thienames, meronem, amoxiclav. After receiving the results of the bacteriological study, the antibacterial drug is changed, taking into account sensitivity of this flora, followed by therapy for 7 days. </span><strong><span lang="EN-US">Conclusions</span></strong><span lang="EN-US">. Studies of microbial flora in patients with bronchopleural diseases reflect specific pathological pathways and can become an important tool for making clinical decisions when managing this complex cohort of patients. The results obtained have practical significance for clinicians: the obtained spectrum of pathogens and established antibiotic sensitivity allow optimizing empirical therapy, reducing the risk of inadequate treatment and improving the prognosis in patients with severe pulmonary-pleural infections.</span></p> |
| title | Microbial flora in patients with bronchopulmonary pathology |
| topic | bronchopleural diseases microbial flora antibacterial therapy |
| url | https://doi.org/10.5281/zenodo.17923418 |