Воспалительные заболевания органов малого таза у женщин – одна из важных проблем здравоохранения во всем мире. Диагноз устанавливается на основании клинических критериев. Эмпирическая терапия антибиотиками является основой стандартного лечения. Устойчивость микроорганизмов к антибиотикам и связанные с этим неудачи стандартной терапии требуют поиска дополнительных мер помимо прописанных в клинических рекомендациях. Системная энзимотерапия представляется наиболее приемлемым инструментом улучшения исходов лечения воспалительных заболеваний органов малого таза.
Pelvic inflammatory disease in women is one of the most important public health problems worldwide. The diagnosis is made based on clinical criteria. Empirical antibiotic therapy is the cornerstone of standard treatment. Antibiotic resistance and associated failures of standard therapy require the search for additional measures beyond those recommended in the clinical guidelines. Systemic enzyme therapy appears to be the most appropriate treatment for improving pelvic inflammatory disease outcomes.
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________________________________________________
1. Ginekologiia. Natsional'noe rukovodstvo. Pod red. GM Savel'evoi, GT Sukhikh, VN Serova, et al. 2-e izd., pererab, i dop. Moscow: GEOTAR-Media, 2022 (in Russian).
2. Canadian Guidelines on Sexually Transmitted Infections – STI-associated syndromes guide: Pelvic inflammatory disease. 2021. Available at: https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitt.... Accessed: 10.05.2024.
3. Simms I, Stephenson JM. Pelvic inflammatory disease epidemiology: What do we know and what do we need to know? Sex Transm Infect. 2000;76:80-7. DOI:10.1136/sti.76.2.80
4. Shafer MA, Sweet RL. Pelvic inflammatory disease in adolescent females. Epidemiology, pathogenesis, diagnosis, treatment, and sequelae. Pediatr Clin North Am. 1989;36(3):513-32. DOI:10.1016/s0031-3955(16)36683-4
5. Goyal M, Hersh A, Luan X, et al. National trends in pelvic inflammatory disease among adolescents in the emergency department. J Adolesc Health. 2013;53(2):249-52. DOI:10.1016/j.jadohealth.2013.03.016
6. Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018;29(2):108-14. DOI:10.1177/0956462417744099
7. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. DOI:10.15585/mmwr.rr7004a1
8. Jennings LK, Krywko DM. Pelvic Inflammatory Disease. 2023. In: Stat Pearls. Treasure Island (FL): StatPearls Publishing, 2024. PMID:29763134
9. Chekmareva IA, Skripchenko DV, Kuznetsov RE, et al. Ultrastructure of interstitial cajal-like cells in acute salpingitis. Morphology. 2020;157(2-3):234-5 (in Russian).
10. Gandahi JA, Chen SF, Yang P, et al. Ultrastructural identifi cation of interstitial cells of Cajal in hen oviduct. Poult Sci. 2012;91(6):1410-7. DOI:10.3382/ps.2011-01918
11. Edelstein L, Fuxe K, Levin M, et al. Telocytes in their context with other intercellular communication agents. Semin Cell Dev Biol. 2016;55:9-13. DOI:10.1016/j.semcdb.2016.03.010
12. Pirtea P, Cicinelli E, De Nola R, et al. Endometrial causes of recurrent pregnancy losses: Endometriosis, adenomyosis, and chronic endometritis. Fertil Steril. 2021;115(3):546-60. DOI:10.1016/j.fertnstert.2020.12.010
13. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927-31. DOI:10.1016/j.fertnstert.2015.06.044
14. Trent M, Bass D, Ness RB, Haggerty C. Recurrent PID, subsequent STI, and reproductive health outcomes: Findings fr om the PID evaluation and clinical health (PEACH) study. Sex Transm Dis. 2011;38(9):879-81. DOI:10.1097/OLQ.0b013e31821f918c
15. Das BB, Ronda J, Trent M. Pelvic inflammatory disease: Improving awareness, prevention, and treatment. Infect Drug Resist. 2016;9:191-7. DOI:10.2147/IDR.S91260
16. Hillier SL, Bernstein KT, Aral S. A review of the challenges and complexities in the diagnosis, etiology, epidemiology, and pathogenesis of pelvic inflammatory disease. J Infect Dis. 2021;224(12 Suppl. 2):S23-8. DOI:10.1093/infdis/jiab116
17. Davis G, Horner P, Price M, et al. What do diagnoses of pelvic inflammatory disease in specialist sexual health services in England tell us about chlamydia control? J Infect Dis. 2021;224(12 Suppl. 2):S113-20. DOI:10.1093/infdis/jiab175
18. Verstraelen H, Swidinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis. 2013;26(1):86-9. DOI:10.1097/QCO.0b013e32835c20cd
19. 2018 United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. Available at: https://www.bashh.org/_userfiles/pages/files/resources/pid2018.pdf. Accessed: 10.05.2024.
20. Vospalitel'nye bolezni zhenskih tazovyh organov. Klinicheskie rekomendatsii Minzdrava Rossii. Moscow. 2021 (in Russian).
21. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease (2019 Interim Update). Available at: https://www.bashh.org/_userfiles/pages/files/resources/pidupdate2019.pdf. Accessed: 10.05.2024.
22. Curry A, Williams T, Penny ML. Pelvic inflammatory disease: Diagnosis, management, and prevention. Am Fam Physician. 2019;100(6):357-64. PMID:31524362
23. Dhasmana D, Hathorn E, McGrath R, et al. The effectiveness of nonsteroidal anti-inflammatory agents in the treatment of pelvic inflammatory disease: A systematic review. Syst Rev. 2014;3:79.DOI:10.1186/2046-4053-3-79
24. Savaris RF, Fuhrich DG, Maissiat J, et al. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database Syst Rev. 2020;8(8):CD010285. DOI:10.1002/14651858.CD010285.pub3
25. Zhu S, Ballard E, Khalil A, et al. Impact of early surgical management on tubo-ovarian abscesses. J Obstet Gynaecol. 2021;41(7):1097-101. DOI:10.1080/01443615.2020.1821620
26. Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64(10):681-9. DOI:10.1097/OGX.0b013e3181b8b0d6
27. Tanwar J, Das S, Fatima Z, Hameed S. Multidrug resistance: An emerging crisis. Interdiscip Perspect Infect Dis. 2014;2014:541340. DOI:10.1155/2014/541340
28. Spellberg B, Bartlett JG, Gilbert DN. The future of antibiotics and resistance. N Engl J Med. 2013;368(4):299-302. DOI:10.1056/NEJMp1215093.
29. Brauner A, Shoresh N, Fridman O, Balaban NQ. An experimental framework for quantifying bacterial tolerance. Biophys J. 2017;112(12):2664-71. DOI:10.1016/j.bpj.2017.05.014
30. Brauner A, Fridman O, Gefen O, Balaban NQ. Distinguishing between resistance, tolerance and persistence to antibiotic treatment. Nat Rev Microbiol. 2016;14(5):320-30. DOI:10.1038/nrmicro.2016.34
31. Blair JM, Webber MA, Baylay AJ, et al. Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol. 2015;13(1):42-51. DOI:10.1038/nrmicro3380
32. Huemer M, Mairpady Shambat S, Brugger SD, Zinkernagel AS. Antibiotic resistance and persistence-Implications for human health and treatment perspectives. EMBO Rep. 2020;21(12):e51034. DOI:10.15252/embr.202051034
33. Jamal M, Tasneem U, Hussain T, Saadia Andleeb S. Bacterial biofilm: its composition, formation and role in human infections. Res Rev J Microbiol Biotechnol. 2015;4(3):1-15.
34. Smirnova TA, Didenko LV, Azizbekyan RR, Romanova YM. Structural and functional characteristics of bacterial biofilms. Microbiology. 2010;79(4):435-46 (in Russian). DOI:10.1134/S002626171004003X
35. Khryanin AA. Microbial Biofilms: Modern Concepts. Antibiot Khimioter = Antibiotics and Chemotherapy. 2020;65(5-6):70-7 (in Russian). DOI:10.37489/0235-2990-2020-65-5-6-70-77
36. Zhao X, Zhao F, Wang J, Zhong N. Biofilm formation and control strategies of foodborne pathogens: Food safety perspectives. RSC Adv. 2017;7(58):36670-83. DOI:10.1039/C7RA02497E
37. Flemming HC, Wingender J, Griebe T, Mayer C. Physico-chemical properties of biofilms. In: Biofilms: Recent advances in their study and control. Amsterdam: Harwood Acad. Publ., 2000.
38. Høiby N, Bjarnsholt T, Givskov M, et al. Antibiotic resistance of bacterial biofilms. Int J Antimicrob Agents. 2010;35(4):322-32. DOI:10.1016/j.ijantimicag.2009.12.011
39. Stewart PS. Mechanisms of antibiotic resistance in bacterial biofilms. Int J Med Microbiol. 2002;292(2):107-13. DOI:10.1078/1438-4221-00196
40. Hall CW, Mah TF. Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria. FEMS Microbiol Lett. 2017;41(3):276-301. DOI:10.1093/femsre/fux010
41. Rather MA, Gupta K, Mandal M. Microbial biofilm: formation, architecture, antibiotic resistance, and control strategies. Braz J Microbiol. 2021;52(4):1701-18.
DOI:10.1007/s42770-021-00624-x
42. Luo Y, Yang Q, Zhang D, Yan W. mechanisms and control strategies of antibiotic resistance in pathological biofilms. J Microbiol Biotechnol. 2021;31(1):1-7. DOI:10.4014/jmb.2010.10021
43. Sternin YuI, Tetz VV, Knorring GY. Modern possibilities of optimization of antibacterial therapy. Chief Physician of the South of Russia. 2010;3(22):17-20 (in Russian).
44. Ustyuzhanin AV, Chistyakova GN, Remizova II. Study of the Wobenzym enzyme preparation effect on the formation of bacterial biofilms. Antibiot Khimioter = Antibiotics and Chemotherapy. 2024;69(1-2):10-4 (in Russian). DOI:10.37489/0235-2990-2024-69-1-2-10-14
45. Biziulevicius GA. Wh ere do the immunostimulatory effects of oral proteolytic enzymes ('systemic enzyme therapy') come from? Microbial proteolysis as a possible starting point. Med Hypotheses. 2006;67(6):1386-8. DOI:10.1016/j.mehy.2006.05.051
46. Sidorenko V, Yakubovich E, Podrezenko E, Krasnitskiy A. Prevention of complications in gynecological patients with inflammatory diseases of the uterine adnexa. Reproductive Health Eastern Europe. 2015;(3):118-23 (in Russian).
47. Tsaregorodtseva MV. Features of therapy of autoimmune ovarian insufficiency in chronic pelvic inflammatory diseases. Medical Council. 2012;(7):24-7 (in Russian).
48. Kokhno NI, Gorshkova OV, Molodtsova LYu. Efficiency of systemic enzyme therapy in the combination treatment of pelvic inflammatory diseases in women. Obstetrics and Gynecology. 2022;12:159-64 (in Russian). DOI:10.18565/aig.2022.294
49. Kupriyanov YA, Zaitsev AV, Bernikov AN, et al. Effectiveness of Wobenzym in combined therapy of chronic bacterial prostatitis. Results of systematic review and meta-analysis. Urology Reports (St.-Petersburg). 2024;14(1):51-64 (in Russian). DOI:10.17816/uroved626639
Авторы
Н.М. Подзолкова1,2, И.Е. Фадеев*1,3, Р.Э. Кузнецов1,2, Т.Н. Полётова1
1ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия; 2ГБУЗ г. Москвы «Городская клиническая больница им. С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Россия; 3ГБУЗ г. Москвы «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы, Москва, Россия
*iefadeev@mail.ru
________________________________________________
Natalia M. Podzolkova1,2, Igor E. Fadeev*1,3, Roman E. Kuznetsov1,2, Tatiana N. Poletova1
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2Botkin City Clinical Hospital, Moscow, Russia; 3Davidovsky City Clinical Hospital, Moscow, Russia
*iefadeev@mail.ru