Особенности микрофлоры ротоглотки у пациентов с осложненным течением тонзиллита

Features of Oropharyngeal Microflora in Patients with Complicated Tonsillitis

Purpose. To assess qualitative and quantitative indicators of oropharyngeal microflora in adult patients with complicated tonsillitis. Materials and methods. A study was conducted to study the qualitative and quantitative indicators of oropharyngeal microflora in patients. The study included 31 patients who were hospitalized in the departments of the Infectious Clinical Hospital No. 1 of the Moscow Department of Health with a diagnosis of acute tonsillitis complicated by paratonsillar abscess. The material for the study was the oropharyngeal discharge. The bacteriological study was carried out by the classical microbiological method using dense nutrient media (5% blood agar, Endo agar, yolk-salt agar, Saburo agar). Isolated cultures were identified by time-of-flight MALDY mass spectrometer UltrafleXtreme ("Bruker daltonics") equipped with a Nd: Yag laser (355 nm) in linear mode. Results. Studies have shown that in the vast majority of patients with complicated tonsillitis, the state of the oropharyngeal mucosa is associated with the qualitative and quantitative composition of the microbiota. In all patients, objective examination revealed hyperemia of the oropharyngeal mucosa, hypertrophy and hyperemia of the tonsils, hyperemia of the palatine arches and uvula. In oropharyngeal smears, 22 types of microorganisms were isolated (gram-positive forms –96% and gram-negative forms –43.3%) in various associations. The most stable obligate association in the oropharynx is streptococcus viridans (100% of the associations), lecithinazonegative staphylococci (66.6%) and conditionally pathogenic neisseria (33.3%), normal inhabitants of the upper respiratory tract, forming a protective biofilm. This study showed inhibition of this association during antimicrobial treatment Already at the prehospital stage, 54.8% people received antibacterial therapy, mainly using protected penicillins and in the hospital all patients (100%) received generation III cephalosporins; reduced the frequency of detection of Neisseria and their quantitative content to 101–103in observed patients. It has been established that a decrease in oropharyngeal seeding mass by normal microflora (quantitative and qualitative) leads to a competitive growth of conditionally pathogenic microflora such as Klebsiella spp., P. aeruginosa, as well as Candida fungi. This microflora was characterized by activation due to an increase in the frequency of excretion (50.0%) and massive seeding (up to 103–105CFU), which may indicate both the activity of the inflammatory process in patients with acute tonsillitis complicated by the development of paratonsillar abscess, and the effect of the duration of antibacterial therapy on the composition of the microflora. © 2025, Professionalnye Izdaniya. All rights reserved.