The changes in the landscape of the vaginal microbiome in patients undergoing complex treatment for mixed recurrent vaginal infections
- Autores: Kutsenko I.I.1, Borovikov I.O.1, Kravtsova E.I.1, Avakimyan A.A.1, Borovikova O.I.1, Andreeva A.A.1
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Afiliações:
- Kuban State Medical University, Ministry of Health of Russia
- Edição: Nº 3 (2024)
- Páginas: 153-162
- Seção: Exchange of Experience
- URL: https://journals.eco-vector.com/0300-9092/article/view/631637
- DOI: https://doi.org/10.18565/aig.2024.67
- ID: 631637
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Resumo
Recurrent mixed vaginal infections (RMVI) have not only become an epidemiological and clinical problem, but they can also lead to serious social and psychological consequences. In order to develop effective strategies for their diagnosis and treatment, it is necessary to understand the mechanisms of both commensalism and pathogenesis. Despite numerous treatment patterns, patients with mixed vaginal infections experience relapses with high frequency, and repeated prescriptions of antibacterial drugs (both systemic and local) only increase microbial resistance. The paper describes the experience of clinical application of complex therapy, including decontamination with a broad-spectrum antiseptic drug (dequalinium chloride), followed by prolonged use of replacement therapy with a probiotic containing lyophilisate of Lactobacillus acidophilus with low doses of estrogens.
Objective: To analyze the clinical and microbiological effectiveness of complex local decontamination (dequalinium chloride) and contamination (Lactobacillus acidophilus in combination with ultra-low-dose estriol) therapy in the treatment of recurrent mixed vaginal infections.
Materials and methods: The study included 124 patients with mixed recurrent vaginal infections (at least two episodes of clinical manifestations per year). Vaginal microbial communities were assessed using microscopic examination (Hay/Ison criteria) and real-time PCR (Femoflor 16). The identification of Lactobacilli species was carried out using the method of mass spectrometry. The vaginal microbiota was assessed in 14 days, 6 and 12 months after the end of the treatment.
Results: Complex local therapy with a prolonged stage of contamination with estriol-containing vaginal probiotics during clinical and microbiological monitoring for 12 months showed a decrease in the number of recurrent mixed vaginal infections by 2.4 times compared with the standard treatment pattern. The patients undergoing prolonged contamination with lactobacillus microflora with donation of microdoses of estriol showed more effective stabilization of the vaginal secretion pH, vaginal microbiocenosis (Hay/Ison criteria) and normalization of the ratio of competitive and weakly competitive lactobacilli, which prevented the development of dysbiotic disorders in the vagina.
Conclusion: The long-term course of contamination therapy with a combination of lactobacilli with ultra-low-dose estriol that promotes the adhesion of lactobacilli to the vaginal epithelium together with local empirical treatment with dequalinium chloride (Fluomizin) is preferable for patients with recurrent vaginal infections.
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Sobre autores
Irina Kutsenko
Kuban State Medical University, Ministry of Health of Russia
Autor responsável pela correspondência
Email: luzum69@mail.ru
ORCID ID: 0000-0003-0938-8286
Dr. Sci. (Med.), Professor, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarIgor Borovikov
Kuban State Medical University, Ministry of Health of Russia
Email: bio2302@mail.ru
ORCID ID: 0000-0001-8576-1359
Dr. Sci. (Med.), Associate Professor, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarElena Kravtsova
Kuban State Medical University, Ministry of Health of Russia
Email: luzum69@mail.ru
ORCID ID: 0000-0001-8987-7375
PhD (Med.), Associate Professor, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarArtem Avakimyan
Kuban State Medical University, Ministry of Health of Russia
Email: 43434340@mail.ru
ORCID ID: 0000-0003-0068-3385
Associate Professor, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarOlga Borovikova
Kuban State Medical University, Ministry of Health of Russia
Email: borovikovaoi@oxy-center.ru
ORCID ID: 0000-0002-7275-9388
Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarAnastasia Andreeva
Kuban State Medical University, Ministry of Health of Russia
Email: oks707@rambler.ru
ORCID ID: 0000-0001-5749-4193
Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology
Rússia, KrasnodarBibliografia
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