Clinical significance of examination of the opportunistic flora in the cervical canal of young women with acute inflammations of the uterine appendages
Objective. To determine the clinical significance of a cultural study of the nonspecific bacterial flora in the cervical canal of young women with acute inflammatory diseases (AID) of the uterine appendages (UA). Subject and methods. The case histories of 87 patients, whose mean age was 16.2±0.9 years, were retrospectively analyzed. The results of a bacteriological study of cervical canal discharge and salpingeal specimens obtained by laparoscopy done as clinically indicated were compared. Purulent salpingitis was laparoscopically verified in all the patients. Purulent UA AID complicated by tuboovarian abscess (TOA) was seen in 32 (36.8%) patients. Results. The proportion of evidence for no cervical canal and salpingeal flora growth was found to be 4.6 and 78.9%, respectively. The structure of the identified cervical canal microbial agents was as follows: bacteria of the family Enterobacteriaceae and enterococci (E. coli, Klebsiella spp., P. mirabilis, M. morganii, and E. faecalis,) were obtained in 25 (27.2%) of 92 specimens. The flora belonging to the genera Staphylococcus (S. aureus, S. epidermidis, S. saprophyticus) and Streptococcus (S. agalactiae, α-hemolysis, β-hemolysis, non-hemolytic spp.) was isolated in almost half of the cervical specimens (45/92 (48.9%)). The growth of the microflora of the genera Corynebacterium spp. and Moraxella (Acinetobacter spp.) was detected in 9 (9.8%) and 3 (3.3%) of the 92 cases, respectively. The structure of inoculation test results for the specimens from the salpinges was scarcely different from that from the cervical canal. Thus, Enterobacteriaceae and enterococci were isolated in 7/21 (33.3%) cases; Staphylococcus spp. and Streptococcus spp. in 12 (57.1%). A. baumanii growth was obtained in one (4.8%) case; P. aeruginosa was also isolated in one (4.8%) case. Negative salpingeal inoculation tests were 4 times more frequent in the patients who had received antibacterial therapy in an outpatient setting. The specific features of the cervical canal and salpingeal microflora were not found in the patients with TOA. Despite the fact that the structure of the isolated opportunistic microflora in the cervical canal and salpinges was similar, the agreement rate for their inoculation test results was only 26.3%. Conclusion. The bacteriological study of the opportunistic microflora of the cervical canal in young women with UA AID is not clinically signif icant. A study of the pattern of the microbial flora from salpingeal discharge, the result of which may be kept in mind in elaborating an individual antibacterial therapy program, is of substantially more importance.