Epiglottis microflora of adult patients with acute epiglottitis

Abstract

Introduction. Nowadays acute infectious-inflammatory processes of upper respiratory tract, including acute epiglottitis retain a high proportion among human pathology. In the literature acute epiglottitis is allocated into an independent nosology as severe acute phlegmonous bacterial inflammation of the epiglottis and hypopharynx. There are currently no clear guidelines on how to classify an acute epiglottitis, as well as protocols for patients at various stages of the pathological process. According to common belief, Haemophilus influenzae type -B (Haemophilus influenza type b (Hib)) is the most common cause of epiglottitis. At present, the main etiological role in the genesis of acute epiglottitis in children belongs to haemophilus influenzae. In adults the causes of the disease are beta hemolytic streptococci groups A, B, pneumococcus, Klebsiella, Pseudomonas, Staphylococcus aureus, herpes simplex virus (type 1) and parainfluenza, and others.The aim of this work is to study: the mucosal microflora of the epiglottis in adult patients with acute epiglottitis and to study sensitivity of certain isolates to antimicrobial agents. Material & methods. 86 adult patients with acute epiglottitis were observed: 36 with abscess form of epiglottitis and 50 - with infiltrative. Microbiological analysis of mucosal swab samples taken from hypopharynx were conducted by the conventional technology: for seeding solid or liquid nutrient medium, followed by allocation of isolith and its microscopic, biochemical and serological identification. Microorganisms were classified according to schemes of Bergy. Antimicrobial susceptibility of each strain was determined in accordance with the guidelines. We used discs with antibacterial drugs. The availability of sensitive and resistant strains of microorganisms to antibiotics was assessed. A mucous membrane of the epiglottis was analyzed through microbiological investigation in 86 patients with acute epiglottitis. As a result, 169 strains of microorganisms were sowed from mucous membrane of epiglottis. Results & discussion. In patients with acute epiglottitis Streptococcus progenies dominated in 33 (23.7%) of cases, H. influenza was detected in 27 cases (19.4%), Streptococcus pneumonia strain was in 21 (12.4%) of cases, 4th place -. Staphylococcus aureus -9.3%. There are different types of: staphylococci strains -29, of Enterococcus spp - 11, gram-negative bacilli -41. Noteworthy fact is the high degree of microbial contamination of patients 107-109 CFU. Conclusion. Acute epiglottitis highest sensitivity was observed to the following medications as cephalosporin, namely cefotaxime while it is variable within the same group (1,2,3 cephalosporin’s generation). The isolated strains showed almost 99,4±1,2% sensitivity to fluoroquinolones, especially to levofloxacin and others (S. aureus, S. pyogenes, S. pneumoniae, H. Influenzae).  There was a high sensitivity to lincosamides - clindamycin; fluoroquinolones- levofloxacin. In 50% of cases, a resistance to the antibiotic penicillin; and macrolide antibiotic, especially the last generations was observed. According to the obtained findings on the sensitivity of microflora to antibiotics cephalosporin’s II- III generation with moderate and severe degrees of severity in combination with fluoroquinolones (all administered parenterally) are used in acute epiglottitis. Use of fluoroquinolones (levofloxacin, ciprofloxacin, and others) is recommended in case of Cephalosporin intolerance, as well as lincosamides (clindamycin, dalatsin, lincomycin)