Antibacterial therapy for ENT diseases during the COVID-19 pandemic
Abstract: В структуре патологии респираторного тракта, в том числе и ЛОР-органов, лидирующую позицию занимают заболевания инфекционно-воспали-тельной природы. Острые респираторные поражения верхних и нижних отделов дыхательных путей составляют 80–97% от всех инфекционных за-болеваний и в 20–30% случаев явлются причиной обращения пациентов разного возраста в медицинские учреждения. Первично причиной развития воспалительных заболеваний ЛОР-органов чаще всего являются вирусные агенты, однако на фоне любой вирусной инфекции… Show more
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Microbial Landscape of the Pharynx in Outpatients during the Pandemic of the New Coronavirus Infection COVID-19: A Retrospective Study
Введение. Пандемия COVID-19 привела к значительным изменениям микрофлоры глотки у пациентов, что требует масштабных исследований на основании доказательной медицины для последующего выбора адекватной терапии. Цель. Определить микробный пейзаж у пациентов с острыми и хроническими воспалительными заболеваниями глотки в период пандемии новой коронавирусной инфекции COVID-19 и сравнить с «доковидным» периодом. Материалы и методы. В ретроспективное исследование 2019–2022 гг. включен анализ 403 образцов отделяемого из глотки у пациентов, обратившихся на амбулаторный прием к врачу-оториноларингологу с жалобами на боль в горле с острыми воспалительными заболеваниями и обострением хронических воспалительных заболеваний глотки на фоне острых респираторных инфекций. Основную группу исследования составили 308 образцов, забранных у пациентов в период пандемии COVID-19. Группу сравнения составили 95 забранных проб при заболеваниях, развившихся при ОРВИ в 2019 г. Проведено сравнение этиологической структуры микробного пейзажа глотки у пациентов в период пандемии COVID-19 и при ОРВИ в «доковидный» период. Результаты. Микробный пейзаж глотки при различных острых заболеваниях и при обострении хронических заболеваний является постоянно меняющимся и зависит от целого ряда причин. У пациентов с болями в горле в период пандемии COVID-19 по сравнению с «доковидным» периодом отмечаются следующие особенности: частота встречаемости грамположительной флоры, преимущественно представленной S. aureus, уменьшилась практически в 2 раза, что обратно пропорционально росту грибковой коинфекции, вызванной Candida albicans (р<0,001). Грамотрицательная флора не является доминирующей в микробном пейзаже заболеваний глотки. Однако получен незначительный подъем частоты встречаемости Kl. pneumoniae до 18% в 2020 г. Выделение Enterococcus, наоборот, имело медленный, но устойчивый тренд к увеличению частоты за все время наблюдения от 5% в 2019 г. до 12% в 2022 г., что может указывать на развитие дисбиоза глотки, возникающего на фоне неадекватного лечения (р>0,05). Выводы. Новая коронавирусная инфекция COVID-19 является новым, до конца не изученным заболеванием, для которого характерны присоединение бактериальной и грибковой коинфекции, активация условно-патогенной микрофлоры и как итог – изменение микробного пейзажа заболеваний глотки. Местные антисептики не заменяют системную антибиотикотерапию, в то же время занимают важное место в лечении воспалительных заболеваний глотки ввиду своего антимикробного спектра действия, обезболивающего и противовоспалительного эффектов, что приводит к синергизму и потенцированию эффектов системной антибактериальной терапии. Introduction. The COVID-19 pandemic has led to significant changes in the microflora of the pharynx, which requires large-scale research based on evidence-based medicine for the subsequent selection of adequate therapy for patients. Purpose. To determine the microbial landscape in patients with acute and chronic inflammatory diseases of the pharynx during the pandemic of the new coronavirus infection COVID-19 and compare it with the pre-Covid period. Materials and methods. In a retrospective study from 2019–2022 included an analysis of 403 samples of pharyngeal discharge from patients who applied for an outpatient appointment with an otolaryngologist with complaints of sore throat with acute and exacerbations of chronic inflammatory diseases of the pharynx against the background of acute respiratory infections. The main study group consisted of 308 samples taken from patients during the COVID-19 pandemic. The comparison group consisted of 95 samples taken from diseases that developed as a result of ARVI in 2019. A comparison was made of the etiological structure of the microbial landscape of the pharynx in patients during the COVID-19 pandemic and with acute respiratory infections in the pre-Covid period. Results. The microbial landscape of the pharynx in various acute and exacerbation of chronic diseases is constantly changing and depends on a number of reasons. In patients with sore throat during the COVID-19 pandemic, compared to the pre-Covid period, the following features are noted: the frequency of occurrence of gram-positive flora, mainly represented by S. aureus, decreased by almost 2 times, which is inversely proportional to the increase in fungal co-infection caused by Candida albicans (p<0.001). Gram-negative flora is not dominant in the microbial landscape of pharyngeal diseases. However, a slight increase in the frequency of occurrence of Kl. pneumoniae up to 18% in 2020 was obtained. Isolation of Enterococcus, on the contrary, had a slow but steady trend towards an increase in the frequency of isolation during the entire observation period from 5% in 2019 to 12% in 2022, which may indicate the development of pharyngeal dysbiosis arising from inadequate treatment (p>0.05). Conclusions. The new coronavirus infection COVID-19 turned out to be a new, not fully understood disease, which is characterized by the addition of bacterial and fungal co-infection, activation of opportunistic microflora and, as a result, a change in the microbial landscape of the pharynx disease. Local antiseptics do not replace systemic antibiotic therapy, but at the same time they occupy an important place in the treatment of inflammatory diseases of the pharynx due to their antimicrobial spectrum of action, analgesic and anti-inflammatory effects, which leads to synergism and potentiation of the effects of systemic antibacterial therapy.
Microbial Landscape of the Pharynx in Outpatients during the Pandemic of the New Coronavirus Infection COVID-19: A Retrospective Study
Введение. Пандемия COVID-19 привела к значительным изменениям микрофлоры глотки у пациентов, что требует масштабных исследований на основании доказательной медицины для последующего выбора адекватной терапии. Цель. Определить микробный пейзаж у пациентов с острыми и хроническими воспалительными заболеваниями глотки в период пандемии новой коронавирусной инфекции COVID-19 и сравнить с «доковидным» периодом. Материалы и методы. В ретроспективное исследование 2019–2022 гг. включен анализ 403 образцов отделяемого из глотки у пациентов, обратившихся на амбулаторный прием к врачу-оториноларингологу с жалобами на боль в горле с острыми воспалительными заболеваниями и обострением хронических воспалительных заболеваний глотки на фоне острых респираторных инфекций. Основную группу исследования составили 308 образцов, забранных у пациентов в период пандемии COVID-19. Группу сравнения составили 95 забранных проб при заболеваниях, развившихся при ОРВИ в 2019 г. Проведено сравнение этиологической структуры микробного пейзажа глотки у пациентов в период пандемии COVID-19 и при ОРВИ в «доковидный» период. Результаты. Микробный пейзаж глотки при различных острых заболеваниях и при обострении хронических заболеваний является постоянно меняющимся и зависит от целого ряда причин. У пациентов с болями в горле в период пандемии COVID-19 по сравнению с «доковидным» периодом отмечаются следующие особенности: частота встречаемости грамположительной флоры, преимущественно представленной S. aureus, уменьшилась практически в 2 раза, что обратно пропорционально росту грибковой коинфекции, вызванной Candida albicans (р<0,001). Грамотрицательная флора не является доминирующей в микробном пейзаже заболеваний глотки. Однако получен незначительный подъем частоты встречаемости Kl. pneumoniae до 18% в 2020 г. Выделение Enterococcus, наоборот, имело медленный, но устойчивый тренд к увеличению частоты за все время наблюдения от 5% в 2019 г. до 12% в 2022 г., что может указывать на развитие дисбиоза глотки, возникающего на фоне неадекватного лечения (р>0,05). Выводы. Новая коронавирусная инфекция COVID-19 является новым, до конца не изученным заболеванием, для которого характерны присоединение бактериальной и грибковой коинфекции, активация условно-патогенной микрофлоры и как итог – изменение микробного пейзажа заболеваний глотки. Местные антисептики не заменяют системную антибиотикотерапию, в то же время занимают важное место в лечении воспалительных заболеваний глотки ввиду своего антимикробного спектра действия, обезболивающего и противовоспалительного эффектов, что приводит к синергизму и потенцированию эффектов системной антибактериальной терапии. Introduction. The COVID-19 pandemic has led to significant changes in the microflora of the pharynx, which requires large-scale research based on evidence-based medicine for the subsequent selection of adequate therapy for patients. Purpose. To determine the microbial landscape in patients with acute and chronic inflammatory diseases of the pharynx during the pandemic of the new coronavirus infection COVID-19 and compare it with the pre-Covid period. Materials and methods. In a retrospective study from 2019–2022 included an analysis of 403 samples of pharyngeal discharge from patients who applied for an outpatient appointment with an otolaryngologist with complaints of sore throat with acute and exacerbations of chronic inflammatory diseases of the pharynx against the background of acute respiratory infections. The main study group consisted of 308 samples taken from patients during the COVID-19 pandemic. The comparison group consisted of 95 samples taken from diseases that developed as a result of ARVI in 2019. A comparison was made of the etiological structure of the microbial landscape of the pharynx in patients during the COVID-19 pandemic and with acute respiratory infections in the pre-Covid period. Results. The microbial landscape of the pharynx in various acute and exacerbation of chronic diseases is constantly changing and depends on a number of reasons. In patients with sore throat during the COVID-19 pandemic, compared to the pre-Covid period, the following features are noted: the frequency of occurrence of gram-positive flora, mainly represented by S. aureus, decreased by almost 2 times, which is inversely proportional to the increase in fungal co-infection caused by Candida albicans (p<0.001). Gram-negative flora is not dominant in the microbial landscape of pharyngeal diseases. However, a slight increase in the frequency of occurrence of Kl. pneumoniae up to 18% in 2020 was obtained. Isolation of Enterococcus, on the contrary, had a slow but steady trend towards an increase in the frequency of isolation during the entire observation period from 5% in 2019 to 12% in 2022, which may indicate the development of pharyngeal dysbiosis arising from inadequate treatment (p>0.05). Conclusions. The new coronavirus infection COVID-19 turned out to be a new, not fully understood disease, which is characterized by the addition of bacterial and fungal co-infection, activation of opportunistic microflora and, as a result, a change in the microbial landscape of the pharynx disease. Local antiseptics do not replace systemic antibiotic therapy, but at the same time they occupy an important place in the treatment of inflammatory diseases of the pharynx due to their antimicrobial spectrum of action, analgesic and anti-inflammatory effects, which leads to synergism and potentiation of the effects of systemic antibacterial therapy.
The developing resistance of microorganisms to the effects of antibacterial drugs creates difficulties in the treatment of purulent diseases. This is especially reasonable in the pandemic of a new coronavirus infection (COVID-19). The aggressive effect of new strains of the virus on the mucous membrane of the nasal cavity and nasopharynx contributes to the occurrence of complications such as acute purulent otitis media and exacerbation of chronic purulent otitis, both during coronavirus infection and in the postcovid period. Even before the start of the pandemic, antibiotic resistance was already one of the big problems in most countries of the world, this was due to the frequent unjustified appointment of systemic antibacterial agents for viral infection, as well as uncontrolled self-medication of the population with all available drugs. Due to the fear of people getting sick with COVID-19 and disagreements among doctors in treatment tactics, the use of systemic antibiotics and hormonal drugs increased already in the first months of the pandemic. In the future, the unjustifiability of this tactic was proved, but many doctors continued to prescribe several systemic antibacterial drugs to patients with uncomplicated viral infection. Under the current conditions, when there is evidence of bacterial infection, it is rational to use local antibacterial drugs, which allows you to quickly reach high concentrations in the focus of inflammation and avoid side effects of systemic antibiotics. Among the existing means in the complex therapy of perforated otitis, a special place belongs to the preparations of the group of quinoxaline derivatives, which include hydroxymethylquinoxalindioxide (Dioxidine). The advantage of the drug is its effectiveness against resistant microorganisms, as well as stimulation of marginal tissue regeneration. This property is especially important in the treatment of perforated otitis media.
Prospects for the application of bacteriophages in the treatment of sinusitis caused by antibiotic-resistant bacterial strains
Purulent diseases in otorhinolaryngology are of great interest due to their widespread prevalence and the objective difficulties of treatment. One of the most frequently encountered nosological forms is purulent sinusitis. A key element in the complex treatment of bacterial sinusitis is systemic antibiotic therapy aimed at the eradication of pathobionts from the focus of infection. However, the increasing worldwide drug resistance of etiologically significant microorganisms complicates antibacterial chemotherapy of purulent sinusitis and raises questions about its future feasibility. The threat of a change from a resistance era to a post-antibiotic era is very significant, given the acute shortage of new antibiotics and the relatively rapid adaptation of bacterial microorganisms to them. The global community is therefore faced with the challenge of finding other drugs with antimicrobial activity. In recent decades, genetically modified virulent bacteriophages and phagolytes isolated on their basis are becoming increasingly attractive in the fight against purulent infections of various localizations caused by drug-resistant bacteria. This literature review focuses on the potential of phage therapy for acute bacterial sinusitis in an era of globally increasing bacterial strain resistance. The article details the causative agents of community-acquired and hospital-acquired acute sinusitis, the main mechanisms of bacterial antibiotic resistance, the effect of virulent phages on bacteria, and studies on the efficacy of phage therapy in the treatment of acute sinusitis. The facts outlined herein clearly indicate the efficacy of phage therapy, as well as therapeutic perspectives on using bacteriophages in the complex treatment of purulent sinusitis caused by antibiotic-resistant microbiota.
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