Abstract and keywords
Abstract (English):
Background. Difficulties in the treatment of the inflammatory process of bone tissue focus the attention of researchers and practitioners on the early identification of pathogens of osteomyelitis, which is the key to successful treatment of the disease. According to publications cited in The Cocrane Library database, the epidemiology and etiological structure of osteomyelitis has undergone significant changes in recent years. The aim of the review is to provide up-to-date information on etiologically significant representatives of the microbial flora in osteomyelitis of the jaws. Methodology. Search work was carried out using international scientific databases PubMed, ScienceDirect, Scopus, Cochrane Collaboration, Elsevier, as well as electronic catalogs Elibrary and Cyberleninka on microbiological aspects of the etiology of osteomyelitis of the jaws. Results. A review of publications has demonstrated the dominant position of representatives of the genus Staphylococcus in the etiological spectrum of chronic post-traumatic osteomyelitis. The predominant pathogen is S. aureus. The proportion of infections mediated by S. epidermidis, S. Saprophyticus is, on average, about 25% of cases. The proportion of representatives of the gram-negative flora Escherichia, Klebsiella, Enterobacter, Citrobacter, Proteus, Providencia, Serratia reaches 23% of cases. According to the above information, the causative agents of gram-negative infections make up 1/5 of the etiological spectrum of chronic osteomyelitis. Pathogenic nosocomial strains of P. aeruginosa are also involved in the formation of chronic inflammation in osteomyelitis. According to the results of published studies, more than a third of cases of chronic osteomyelitis are mediated by microbial associations. The latter are dominated by S. aureus, S. epidermidis and, less frequently, E. faecalis. At the same time, dynamic analysis showed the variability of the microbial composition of associations, which determines additional difficulties in choosing the actual etiotropic therapy and may cause further progression of the pathological process. Conclusions. Implementation of effective methods of therapy requires new informative diagnostic approaches. However, the sensitivity of routine microbiological analyzes is not high enough. At the present stage, the diagnostic value of molecular genetic methods based on the polymerase chain reaction has been recognized.

literature review, osteomyelitis of the jaw, etiology, microflora of purulent foci, microbiological aspect of osteomyelitis, microbial associations of osteomyelitis

1. Terehova R.P., Mitish V.A., Pashalova Yu.S., Skladan G.E., Prudnikova S.A., Blatun L.A. Vozbuditeli osteomielita dlinnyh kostey i ih rezistentnost'. Rany i ranevye infekcii. 2016;3(2):24-30. [R.P. Terekhova, V.A. Mitish, Yu.S. Paskhalova, G.E. Skladan, S.A. Prudnikova, L.A. Blatun. Causative agents of osteomyelitis of long bones and their resistance. Wounds and wound infections. 2016;3(2):24-30. (In Russ.)]. https://doi.org/10.17650/2408-9613-2016-3-2-24-30.

2. Kavanagh N., Ryan E.J., Widaa A., Sexton G., Fennell J., O'Rourke S., Cahill K.C., Kearney C.J., O'Brien F.J., Kerrigan S.W. Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions // Clin Microbiol Rev. - 2018;31(2):e00084-17. https://doi.org/10.1128/CMR.00084-17.

3. Conterno L.O., Turchi M.D. Antibiotics for treating chronic osteomyelitis in adults (Review) // Cochrane Database Syst Rev. - 2013;(9):CD004439. https://doi.org/10.1002/14651858.CD004439.pub3.

4. Timofeev A.A. Rukovodstvo po chelyustno-licevoy hirurgii i hirurgicheskoy stomatologii. Kiev : «Chervona Ruta-Ture». 2002. [A.A. Timofeev. Guide to maxillofacial surgery and surgical dentistry. Kyiv : "Chervona Ruta-Ture". 2002. (In Russ.)]. https://e-stomatology.ru/pressa/literatura/hirurgia/

5. Mironov S.P., Ciskarashvili A.V., Gorbatyuk D.S. Hronicheskiy posttravmaticheskiy osteomielit kak problema sovremennoy travmatologii i ortopedii (obzor literatury). Geniy ortopedii. 2019;25(4):610-621. [S.P. Mironov, A.V. Ciskarashvili, D.S. Gorbatyuk. Chronic post-traumatic osteomyelitis as a problem of modern traumatology and orthopedics (literature review). Orthopedic Genius. 2019;25(4):610-621. (In Russ.)]. https://doi.org/10.18019/1028-4427-2019-25-4-610-621.

6. Klyushin N.M., Naumenko Z.S., Rozova L.V., Leonchuk D.S. Mikroflora hronicheskogo osteomielita plechevoy kosti. Geniy ortopedii. 2014;(3):57-59. [N.M. Klyushin, Z.S. Naumenko, L.V. Rozova, D.S. Leonchuk. Microflora of chronic osteomyelitis of the humerus. Orthopedic Genius. 2014;(3):57-59. (In Russ.)]. https://cyberleninka.ru/article/n/mikroflora-hronicheskogo-osteomielita-plechevoy-kosti

7. García Del Pozo E., Collazos J., Cartón J.A., Camporro D., Asensi V. Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes // Rev Esp Quimioter. - 2018;31(3):217-225. https://pubmed.ncbi.nlm.nih.gov/29756429/

8. Kameka A.L., Leonova S.N. Mehanizmy narusheniya processa regeneracii pri zameschenii defektov kostnoy tkani goleni u bol'nyh s hronicheskim travmaticheskim osteomielitom. Byulleten' VSNC SO RAMN. 2008;62(4):23-32. [A.L. Kameka, S.N. Leonova. Mechanisms of violation of the process of regeneration during the replacement of defects in the bone tissue of the lower leg in patients with chronic traumatic osteomyelitis. Bulletin of VSNC SO RAMS. 2008;62(4):23-32. (In Russ.)]. https://cyberleninka.ru/article/n/mehanizmy-narusheniya-protsessa-regeneratsii-pri-zameschenii-defektov-kostnoy-tkani-goleni-u-bolnyh-s-hronicheskim-travmaticheskim

9. Allison D.C., Holtom P.D., Patzakis M.J., Zalavras C.G. Microbiology of bone and joint infections in injecting drug abusers // Clin Orthop Relat Res. - 2010;468(8):2107-2112. https://doi.org/10.1007/s11999-010-1271-2.

10. Josse J., Velard F., Gangloff S.C. Staphylococcus aureus vs. Osteoblast: Relationship and Consequences in Osteomyelitis // Front Cell Infect Microbiol. - 2015;5:85. https://doi.org/10.3389 fcimb.2015.00085.

11. Wright K.M., Friedland J.S. Differential regulation of chemokine secretion in tuberculous and staphylococcal osteomyelitis // J Bone Miner Res. - 2002;17(9):1680-1690. https://doi.org/10.1359/jbmr.2002.17.9.1680. Valour F., Rasigade J.P., Trouillet-Assant S., Gagnaire J., Bouaziz A., Karsenty J., Lacour C., Bes M., Lustig S., Bénet T., Chidiac C., Etienne J., Vandenesch F., Ferry T., Laurent F. Delta-toxin production deficiency in Staphylococcus aureus: a diagnostic marker of bone and joint infection chronicity linked with osteoblast invasion and biofilm formation // Clin Microbiol Infect. - 2015;21(6):568.e1-11. https://doi.org/10.1016/j.cmi.2015.01.026. Hamza T., Li B. Differential responses of osteoblasts and macrophages upon Staphylococcus aureus infection // BMC Microbiol. - 2014;14:207. https://doi.org/doihttps://doi.org/10.1186/s12866-014-0207-5.

12. Junka A., Szymczyk P., Ziółkowski G., Karuga-Kuzniewska E., Smutnicka D., Bil-Lula I., Bartoszewicz M., Mahabady S., Sedghizadeh P.P. Bad to the Bone: On In Vitro and Ex Vivo Microbial Biofilm Ability to Directly Destroy Colonized Bone Surfaces without Participation of Host Immunity or Osteoclastogenesis // PLoS One. - 2017;12(1):e0169565. https://doi.org/10.1371/journal.pone.0169565.

13. Yamashita Y., Takeshita T. The oral microbiome and human health // J Oral Sci. - 2017;59(2):201-206. https://doi.org/10.2334/josnusd.16-0856.

14. Kryukov A.I., Kunel'skaya N.L., Gurov A.V., Izotova G.N., Starostina A.E., Lapchenko A.S. Kliniko-mikrobiologicheskaya harakteristika disbioticheskih izmeneniy slizistoy obolochki polosti rta i rotoglotki. Medicinskiy sovet. 2016;(6):32-35. [A.I. Kryukov, N.L. Kunel'skaya, A.V. Gurov, G.N. Izotova, A.E. Starostina, A.S. Lapchenko. Clinical and microbiological characteristics of dysbiotic changes in the mucous membrane of the oral cavity and oropharynx. Medical advice. 2016;(6):32-35. (In Russ.)]. https://doi.org/10.21518/2079-701X-2016-6-32-35

15. Zhang X., Lu Q., Liu T., Li Z., Cai W. Bacterial resistance trends among intraoperative bone culture of chronic osteomyelitis in an affiliated hospital of South China for twelve years // BMC Infect Dis. - 2019;19(1):823. https://doi.org/10.1186/s12879-019-4460-y.

16. Pigrau C., Almirante B., Rodriguez D., Larrosa N., Bescos S., Raspall G., Pahissa A. Osteomyelitis of the jaw: resistance to clindamycin in patients with prior antibiotics exposure // Eur J Clin Microbiol Infect Dis. - 2009;28(4):317-323. https://doi.org/10.1007/s10096-008-0626-z.

17. Kabanova A.A. Vozbuditel' vospalitel'nyh zabolevaniy chelyustno-licevoy oblasti v oblastnyh stacionarah Belarusi. Medicinskiy vestnik Severnogo Kavkaza. 2017;12(4):424-427. [A.A. Kabanova. The causative agent of inflammatory diseases of the maxillofacial region in the regional hospitals of Belarus. Medical Bulletin of the North Caucasus. 2017;12(4):424-427. (In Russ.)]. https://doi.org/10.14300/mnnc.2017.12119

18. Tokbergenova A.T. Osobennosti razvitiya gnoyno-vospalitel'nyh processov chelyustno-licevoy oblasti. Medicina i ekologiya. 2018;(1):36-46. [A.T. Tokbergenova. Features of the development of purulent-inflammatory processes in the maxillofacial region. Medicine and ecology. 2018;(1):36-46. (In Russ.)]. https://cyberleninka.ru/article/n/osobennosti-razvitiya-gnoyno-vospalitelnyh-protsessov-chelyustnolitsevoy-oblasti

19. Mustafaev M.Sh., Kudaev Sh.S., Haraeva Z.F. Faktory persistencii mikroorganizmov, vydelennyh pri gnoyno-vospalitel'nyh oslozhneniyah perelomov chelyustnyh kostey. Fundamental'nye issledovaniya. 2005;5:78-79. [M.Sh. Mustafaev, Sh.S. Kudaev, Z.F. Kharaeva. Persistence factors of microorganisms isolated in purulent-inflammatory complications of fractures of the jaw bones. Basic research. 2005;5:78-79. (In Russ.]. https://fundamental-research.ru/ru/article/view?id=6085

20. Mitrofanova N.N., Lebedev M.V., Mel'nikov V.L., Kupryushin A.S. K voprosu antibiotikorezistentnosti etiologicheskih agentov gnoyno-vospalitel'nyh zabolevaniy u pacientov otdeleniya chelyustno-licevoy hirurgii mnogoprofil'nogo stacionara. Medicinskie nauki. Klinicheskaya medicina. 2017;43(3):49-56. [N.N. Mitrofanova, M.V. Lebedev, V.L. Mel'nikov, A.S. Kupryushin. On the issue of antibiotic resistance of etiological agents of purulent-inflammatory diseases in patients of the department of maxillofacial surgery of a multidisciplinary hospital. Medical Sciences. Clinical medicine. 2017;43(3):49-56. (In Russ.)]. https://doi.org/10.21685/2072-3032-2017-3-6

21. Nesterov A.V., Lebedev M.V., Zaharova I.Yu. Chastota i struktura gnoyno-vospalitel'nyh zabolevaniy chelyustno-licevoy oblasti (po materialam otdeleniya chelyustno-licevoy hirurgii oblastnoy klinicheskoy bol'nicy im. N. N. Burdenko). Vestnik Penzenskogo gosudarstvennogo universiteta. 2017;17(1):65-72. [A.V. Nesterov, M.V. Lebedev, I.Yu. Zaharova. The frequency and structure of purulent-inflammatory diseases of the maxillofacial region (based on the materials of the Department of Maxillofacial Surgery of the Regional Clinical Hospital named after N. N. Burdenko). Bulletin of the Penza State University. 2017;17(1):65-72. (In Russ.)]. https://cyberleninka.ru/article/n/chastota-i-struktura-gnoyno-vospalitelnyh-zabolevaniy-chelyustno-litsevoy-oblasti-po-materialam-otdeleniya-chelyustno-litsevoy

22. Mironova A.V., Korshukova O.A. Faktory virulentnosti enterokokkov. Zdorov'e. Medicinskaya ekologiya. Nauka. 2015;60(2):73-78. [A.V. Mironova, O.A. Korshukova. Enterococcal virulence factors. Health. Medical ecology. The science. 2015;60(2):73-78. (In Russ.)]. https://applied-research.ru/ru/article/view?id=6587

23. Spyropoulou V., Dhouib Chargui A., Merlini L., Samara E., Valaikaite R., Kampouroglou G., Ceroni D. Primary subacute hematogenous osteomyelitis in children: a clearer bacteriological etiology // J Child Orthop. - 2016;10(3):241-246. https://doi.org/10.1007/s11832-016-0739-3.

24. Nishitani K., Sutipornpalangkul W., de Mesy Bentley K.L., Varrone J.J., Bello-Irizarry S.N., Ito H., Matsuda S., Kates S.L., Daiss J.L., Schwarz E.M. Quantifying the natural history of biofilm formation in vivo during the establishment of chronic implant-associated Staphylococcus aureus osteomyelitis in mice to identify critical pathogen and host factors // J Orthop Res. - 2015;33(9):1311-1319. https://doi.org/10.1002/jor.22907.

25. Mariani B.D., Martin D.S., Chen A.F., Yagi H., Lin S.S., Tuan R.S. Polymerase Chain Reaction molecular diagnostic technology for monitoring chronic osteomyelitis // J Exp Orthop. - 2014;1(1):9. https://doi.org/10.1186/s40634-014-0009-6.

26. Ferroni A., Al Khoury H., Dana C., Quesne G., Berche P., Glorion C., Péjin Z. Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unit // Clin Microbiol Infect. - 2013;19(9):822-828. https://doi.org/10.1111/clm.12031.

27. Brakstad O.G., Aasbakk K., Maeland J.A. Detection of Staphylococcus aureus by Polymerase Chain Reaction Amplification of the nuc // Gene J Clin Microbiol. - 1992;30(7):1654-1660. https://doi.org/10.1128/jcm.30.7.1654-1660.1992.

28. Shibata S., Tanizaki R., Watanabe K., Makabe K., Shoda N., Kutsuna S., Nagamatsu M., Oka S., Ohmagari N. Escherichia coli Vertebral Osteomyelitis Diagnosed According to Broad-range 16S rRNA Gene Polymerase Chain Reaction (PCR) // Intern Med. - 2015;54(24):3237-3240. https://doi.org/10.2169/internalmedicine.54.5066.

Login or Create
* Forgot password?