RU2134583C1 - Method of sanitation of women with massive microbe dissemination of breast milk - Google Patents

Abstract

FIELD: medicine, particularly, pediatrics; applicable in antibacterial treatment of mammary glands of women ll with any form of mastitis, various infection and inflammatory diseases after clinical recovery, and practically healthy women with massive microbe dissemination of breast milk. SUBSTANCE: method includes relaxation massage of mammary gland for 3-10 min; applications of suspension of microorganisms of normal microflora of intestine additionally containing 1/8 wt. % of microbiological protective film-forming medium, to region of papilla and areola of mammary gland with exposure for 30-40 min. Medium is used in the form of dry fat-free milk or mixture of lactose, dextran, thiourea and absorbic acid. Preparation is applied in doses ensuring presence of microbic cells in concentration of not less than 10⁶ cells per sq.cm of skin. Application of zoobiotics, for instance, bifidumbacterin or lactobacterin is also possible. At the end of treatment mammary gland is subjected to tonic massage. Procedure of sanitation is performed twice a day (in the morning and evening) with course covering 5-7 days. The method provides optimal conditions for production and direct access to excretory ducts and cisterns of mammary glands of multifunctional complex of regulating metabolites possessing sparing effect with respect to conventionally pathogenic microorganisms and nonspecific anabiosis stimulating action on cells of microorganisms in combination with conditions of maximum prolongation of isolation of conventionally pathogenic microorganisms from oxygen at absence of negative action both on organism as a whole, and on microbic homeostasis of feeding mother and baby. EFFECT: higher efficiency. 11 cl, 2 tbl

Description

 The invention relates to medicine, namely to pediatrics, and can be used for antibacterial treatment of the mammary glands in women who have had any form of mastitis or various infectious and inflammatory diseases with localization on the mammary gland or outside it (nipple cracks, endometritis, phlebitis, acute intestinal diseases, pyelonephritis) after clinical recovery, as well as in practically healthy women with massive microbial contamination of breast milk.

 In recent years, the role of various opportunistic pathogens as a cause of intestinal disorders in children in the first months of life has significantly increased. The leading place among them belongs to staphylococcus. Intestinal lesions with staphylococcal infection in young children are most often caused by the species Staphilococcus aureus, sometimes S. epidermidis. The source of infection for newborns can be permanent carriers of staphylococcus and, in the first place, the mother, especially if she has various purulent-inflammatory diseases of staphylococcal etiology (mastitis, endometritis, etc.). It has been established that breast milk, massively seeded with opportunistic microorganisms (UPM), provides a food-borne route of transmission of the infection to the baby, and also activates the contact transmission mechanism. In recent years, the possibility of isolating staphylococci (and, first of all, S.aureus) in massive quantities from breast milk has been shown not only in women who have mastitis or other infectious and inflammatory diseases with localization on the mammary gland or outside it after clinical recovery, but and practically healthy women / 1, 2, 3 /.

 Known methods for the rehabilitation of bacterial carriers of pathogenic staphylococcus, including nursing mothers (in particular, in maternity hospitals), by subcutaneous, intramuscular or oral administration of the drug into the patient's body. So, there are known methods of rehabilitation using staphylococcal toxoid (administered subcutaneously, a course of 1 to 9 injections in increasing doses); staphylococcal bacteriophage (administered subcutaneously or intramuscularly in increasing doses, the course is from 3-5 to 7-8 injections of the drug); antibiotics, for example, oxacillin sodium salt, ampicillin trihydrate, polymyxin M sulfate, zeporin, etc. in pharmacopoeially accepted dosages and modes (mainly orally). Also use the combined use of staphylococcal bacteriophage with antibiotics / 4, 5, 6 /. There is also a method of sanitation by using a 1% alcohol solution of chlorophyllipt, which is administered orally to the mother's body 25-30 drops 3 times a day for 10-14 days, followed by repeated bacteriological analysis of milk, based on which the question of the possibility of renewal breastfeeding / 1, 2 /.

 However, the considered analogous methods do not provide the technical result achieved using the invention. This is due to the fact that these drugs, apparently, have a limited ability to penetrate into the internal cavities of the mammary glands - milk-draining ducts and milk "tanks", where a significant amount of UPM, in particular S. aureus, is localized, which in some cases does not allow create in these areas the concentrations of the drug necessary and sufficient to reduce the level of contamination of breast milk to normal. The high species-specificity of the toxoid and the bacteriophage determines their relatively low efficiency in complex massive infection. Antibiotics, having a non-specific antibacterial effect on the body as a whole, simultaneously negatively affect the microbial homeostasis of the nursing mother (in particular, the intestinal microflora), as well as immunity indicators, which, in turn, can indirectly negatively affect the child's colonization resistance, causing intestinal disorders, as well as its immunobiological reactivity. Such negative effects can be significantly increased in cases of infection with antibiotic-resistant strains of microorganisms, when it becomes necessary to adjust the course of treatment by changing the antibiotic or increasing its dose. In addition, all these drugs, when taken, can in some cases cause side effects in the form of allergic reactions, nausea, vomiting, etc. All this eliminates the possibility of breastfeeding in the course of rehabilitation.

 Closest to the claimed solution on the set of essential features is a method of sanitizing bacteriocarriers of pathogenic staphylococcus, including women with massive microbial contamination of breast milk, by external application of staphylococcal bacteriophage liquid in the form of daily lotions or wet dressings on the affected area at a dose of 5 ml and more depending on the individual characteristics of the clinical case / 5 /.

 However, the prototype method also cannot ensure the achievement of the technical result of the invention. This is due to the fact that the staphylococcal bacteriophage apparently has (as mentioned above) limited ability to penetrate the inaccessible internal cavities of the mammary glands, which, when applied externally (as well as in the case of its subcutaneous or intramuscular injection), does not allow directly affect the foci of infection located in the excretory ducts and milk "tanks", which leads to the relative duration of the course of treatment. In addition, with the external use of a staphylococcal bacteriophage, local allergic reactions are possible, which are manifested by soreness, hyperemia and swelling. All this (including the relatively low bacteriophage effectiveness noted above for complex massive infection) excludes the possibility of breastfeeding until the end of the rehabilitation course.

 The objective of the invention is to provide a method for the reorganization of women with massive microbial contamination of breast milk, providing optimal conditions for the production and direct access to the excretory ducts and "tanks" of the mammary glands of a multifunctional complex of regulatory metabolites, which has a depressing effect against UPM, in particular staphylococci, and non-specific anabiostimulating action on the cells of microorganisms, in combination with the conditions for maximum prolonged isolation of UPM from acid Orodes in the absence of negative effects both on the body as a whole, and on the microbial homeostasis nursing mother and child.

The problem is solved in that in the method of reorganization of women with massive microbial contamination of breast milk, including the application of the drug to the affected area, according to the invention, before applying the drug, a relaxing massage of the breast is performed for 3-10 minutes. As a medicine, a suspension of microorganisms of normal intestinal microflora, which are mainly in active growth phases (i.e., in the lag phase or exponential phase / 7 /), is used, the suspension additionally containing 1-8 wt.% Microbiological protective potentially film-forming medium. Applications of the suspension are carried out on the nipple and areola of the mammary gland with an exposure of 30-40 minutes, after which the skin surface is heard. As microorganisms of normal intestinal microflora, mainly bifidobacteria or lactobacilli are used. As protective media capable of forming a protective layer (film) upon drying, standard microbiological media used in the dehydration of microorganisms of the indicated species are used, for example, skimmed milk powder (medium N 1) or a medium containing 72-90% lactose, 2-6 % dextran, 2-6% thiourea and 2-6% ascorbic acid (medium N 2). The drug is applied to the skin in doses, allowing to obtain the presence of microbial cells in a concentration of at least 10 ⁶ cells per cm ^{2 of} skin. It is possible to use industrially produced biological preparations obtained from microbes - representatives of the normal intestinal microflora, the so-called "eubiotics" / 5, 8, 9 / as a medicine, provided that they contain a protective medium of the indicated type in the required concentrations, or possibly the use of these drugs after the additional introduction of a protective environment of this type and bringing its concentration to the required values. As eubiotics, it is advisable to use bifidumbacterin or lactobacterin, which are administered in an amount of 2.5-5 doses of the drug. After drying the skin surface, an additional tonic massage of the breast is performed. The rehabilitation procedure is carried out 2 times a day (morning and evening) for 5-7 days.

To select the optimal content of the protective medium in the suspension of microorganisms, the effect of various concentrations of protective environments in the suspension of the Bifidobacterium bifidum culture on the growth of the S. aureus culture was studied. For this, 5 ml of a suspension of a 4-hour culture of B. bifidum N 791 grown on Blaurock medium / 10 / was centrifuged at 15,000 rpm for 15 minutes. An aqueous solution of the protective medium N 1 or N 2 was added to the obtained cell concentrate until the content of 10 ⁷ cells / ml B. bifidum and 0.005-0.12 g of the protective medium per ml of suspension were contained in the final product. The culture of S. aureus was made from a suspension with its physiological solution at a dilution of 1: 100 (0.1) on yolk-salt agar with the addition of 10% by weight of a suspension of B. bifidum cells containing a different amount of protective medium spilled in Petri dishes. Colony counting on a plate was carried out after 48 hours of incubation at 37.5 ^° C. Staphylococcus titer was determined depending on colony formation.

 The results are presented in table 1.

 From the data of table 1 shows that the optimal is the content of the protective environment in the amount of 1-8 wt.%. At low concentrations of protective media (less than 1 wt.%) There is no possibility of the formation of an insulating film. An increase in the content of protective media in a suspension of more than 8 wt.% Not only does not lead to an increase in the inhibitory effect of bifidobacteria on S. aureus, but may even contribute to its decrease due to the increased viscosity, which can inhibit the proliferation of bifidobacteria and regulatory metabolites. In addition, when using suspensions with a high content of protective media, subjective negative skin sensations were observed in patients.

To select the optimal concentration of a suspension of microorganisms for applications, we studied the effect of various concentrations on the effectiveness of rehabilitation. To this end, sanitation was carried out using the claimed method in 160 practically healthy women aged 17 to 36 years with a level of contamination of breast milk S. aureus 5 • 10 ³ CFU / ml. Moreover, women were divided into 4 groups (40 people each), in each of which various preparations were used for applications. Each of the groups included 4 subgroups (10 people each), in each of which different doses of the same preparation were used for applications. The exposure of applications in all groups was 35 min. Applications were carried out using sterile gauze napkins with a single-use surface area of 0.1-0.3 dm ² .

Groups 1, 2 - applications with a suspension of a 6-hour B. bifidum culture, strain 791 grown on a nutrient broth with the addition of NaCl / 10 / containing 5 wt.% Protective medium N 1 (group 1) or N 2 (group 2) in doses that provide concentrations of 10 ⁵ , 10 ⁶ , 10 ⁷ , 10 ⁸ cells of microorganisms per 1 cm ^{2 of} skin (1-4 subgroups of the 1st group and 5-8 subgroups of the 2nd group);
Groups 3 and 4 — applications of suspensions of preparations of bifidumbacterin (group 3) and lactobacterin (group 4) dissolved in water at the rate of 1; 2.5; 5 and 7.5 doses of the drug (with a content of 1 dose of at least 10 ⁸ - 10 ⁹ live microbial cells) in 5 ml of water (subgroups 9-12 and 13-16, respectively).

Remediation results showed that the application of suspensions of microorganisms in doses providing a concentration of 10 ⁶ or more cells per 1 cm ^{2 of} skin allowed us to achieve a positive reorganization result (a decrease in the seeding of S. aureus breast milk to a level of less than 250 CFU / ml) in 80-90% cases, while at concentrations of less than 10 ⁶ cells per 1 cm ^{2 of} skin, a positive result was observed only in 10-20% of cases. It was also established that when using industrially produced drugs - bifidumbacterin and lactobacterin, a suspension containing 2.5-5 doses of the drug is optimal (a positive result of rehabilitation in 80-90% of women). A decrease in the concentration of the suspension led to a decrease in the efficiency of rehabilitation (at 1 dose the effectiveness was 10-20%), and with an increase in the concentration to 7.5 doses of the drug, the performance indicators of the rehabilitation remained at the same level.

To select the optimal exposure of the applications, we studied the effect of time indicators on the effectiveness of rehabilitation and on the condition of the skin of the nipple and areola after the application. To this end, sanitation was carried out using the claimed method in 180 practically healthy women aged 17 to 36 years with a level of contamination of breast milk S. aureus 5 • 10 ³ CFU / ml. At the same time, women were divided into 4 groups (60 people each), in each of which different preparations were used for applications in the same concentrations. Each of the groups included 4 subgroups (10 people each), in each of which the drug was applied with different exposures. Accessories for applications were similar to those described above.

Groups 1, 2 - applications with a suspension of a 6-hour culture of B. bifidum strain 791 grown on a nutrient broth with the addition of NaCl / 10 / containing 5 wt.% Protective medium N 1 (group 1) or N 2 (2- I group), in doses that provide concentrations of 10 ⁶ - 10 ⁷ microorganism cells per 1 cm ^{2 of} skin, with an exposure of 10, 20, 30, 40 50 and 60 min (1-6 subgroups of the 1st group and 7-12 subgroups 2 th group);
3, 4 groups - applications of suspensions of preparations of bifidumbacterin (group 3) and lactobacterin (group 4), dissolved at the rate of 5 doses of the drug in 5 ml of water at an exposure of 10, 20, 30, 40, 50 and 60 minutes (13 -18 and 19-24 subgroups, respectively).

 Remediation results showed that an exposure of 30-40 minutes provided a positive reorganization result for all preparations used for applications in 80-90% of cases in the absence of negative skin reactions. A decrease in time indices led to a decrease in the efficiency of rehabilitation (with an exposure of 20 minutes, a positive effect was observed in 60-70% of cases, and with an exposure of 10 minutes in 10-30% of cases). An increase in exposure over 40 min did not lead to a significant increase in the efficiency of rehabilitation, however, starting from an exposure of 50 min, in some cases (10-20%) complications were observed in the form of maceration of the skin of the nipple, and the frequency of negative reactions increased with increasing exposure.

 The achievement of the technical result provided by the invention is due to the following. It is known that in the process of development, bacterial cells release products of their metabolism into the environment, including substances with regulatory functions. The claimed method is based on the use of a relatively new area of practical microbiology, namely the possible use of metabolites of regulatory action secreted by the cells of microorganisms when exposed to stress factors (thermal shock, radiation, treatment with chemical agents, dehydration, etc.). It is known that many strains of microorganisms secrete protein toxins called bacteriocins (for example, colicins - toxins produced by strains of Echerichia coli), which are active only against closely related strains, but, as a rule, not affecting the culture - the producer of this toxin / 7 /. It is known that bifidobacteria and lactobacilli, which are representatives of the normal intestinal microflora, have antagonistic activity against pathogenic and conditionally pathogenic microorganisms, producing a variety of bactericidal and bacteriostatic substances, including substances like antibiotics / 11 /. By studying the patterns of development of microbial cultures (mainly E. coli cultures), it was proved that there is a system of specific autometabolic regulation of the development of microbial populations, which is based on the production of substances by the bacterial cells determined by mechanisms such as feedback that can have both stimulating and inhibitory effects producer culture / 12, 13 /. At the same time, it has been shown that a number of autometabolic factors may have a nonspecific regulatory effect on microorganisms of various taxonomic groups. In particular, this property was used in the development of a new group of stimulants, where either the supernatant of native culture cells during cultivation or the supernatant of cells previously exposed to non-lethal stress factors (weak constant electric field, thermal shock, moving from nutrient medium in conditions of starvation, freezing-thawing, etc.) / 14, 15 /. Considering the potential functions of bioregulators of various nature, we proceed from the fact that they are secreted by microbial cells in order to maintain the population at a certain optimal level for specific conditions, which ensures, inter alia, the preservation of the population in adverse conditions. In this case, depending on the nature of the stress factor, metabolites of various functional purposes are likely to be produced, for example, aimed at increasing mutagenic activity, stimulating growth, and transferring the cell to an inactive, in particular, anabiotic state. The prevalence of metabolites of the latter group, according to the authors of the claimed solution, is most likely in the absence of ingredients necessary for the normal functioning of microorganisms (water, carbon sources, nitrogen, specific growth factors, etc. / 7 /), which may be due to including competition of microorganisms. One of the conditions for the appearance of metabolites of this type is dehydration. It should be noted that the intensity of metabolite excretion into the extracellular medium will depend on the functional state of the cell (growth phase), the intensity of the negative factor, the nature of the cells, the presence of protective and other additives in the extracellular space, etc. .

 In the process of implementing the proposed method, the implementation of a massage that relaxes the smooth muscle of the mammary gland, helps to expand the excretory ducts and creates optimal conditions for access of the active principle of the drug to the internal cavities and channels of the mammary glands (including milk "tanks"), where it is localized a significant number of UPM, and, first of all, staphylococci. When applied to the skin of the nipple and areola, a sufficiently concentrated suspension of microorganisms (bifidobacteria and lactobacilli) in the active phase of growth, i.e. at the stage of maximum release of specific action of autoregulatory metabolites into the environment, microbial cells are adsorbed both on the skin surface and in the excretory ducts of the mammary gland. However, after microorganisms get on the skin and in the internal channels, the transition from favorable to cell development conditions to unfavorable due to dehydration, lack of nutrients necessary for the growth of the population, and competition from microorganisms of other groups, in particular staphylococci. Under these conditions, an active large microbial suspension population, adsorbed both on the skin and in the internal channels of the mammary gland, carries out a volley release of a multifunctional complex of metabolites (or, possibly, multifunctional metabolites), which have both bactericidal action against competing species and non-specific anabiostimulating action. Due to their small size, these metabolites are able to penetrate deeply into the excretory ducts of the mammary glands up to the mammary "cisterns", exerting a depressing effect and reducing the number of staphylococci in the body in an inactive stationary phase of development.

 In parallel, drying (dehydration) of the suspension takes place with the formation on the skin surface and / or in the excretory ducts of a film that isolates staphylococci (which are known to be optional anaerobes) from oxygen, and thereby hindering their normal life, which also contributes to a decrease in their population. The process under consideration has a much less pronounced negative effect on the microbial cells of the drug due to the fact that the cells arrive already adapted to the protective environment, and also have greater (compared with staphylococci) opportunities for oxygen production, because located in the upper layers of the insulating film. As for bifidobacteria, they (unlike staphylococci and lactobacilli, which are facultative anaerobes) are pure anaerobes, for the development of which oxygen is practically not needed.

 Another function of the protective environment is to increase the strength of fixation of microbial cells of the drug on the skin and on the walls of the excretory ducts of the mammary glands. This allows you to ensure the active effect of the drug for at least 20-60 minutes, thereby prolonging the sanitizing regime, and during all this time, the adaptation of staphylococci to changing conditions is practically excluded.

 The combined effect of the above factors provides the maximum suppression of the culture of staphylococci, including and in inaccessible internal areas of the mammary gland, as a result of which the staphylococcus titer in breast milk drops sharply. At the same time, the latter is enriched with both microorganisms that contribute to the formation of normal intestinal microflora in the child, and metabolites that stimulate the growth of microflora favorable for the child and suppression of UPM. All this allows you to breastfeed the child during the entire course of rehabilitation. Carrying out after the applications with the claimed preparations a tonic massage, as a result of which milk is ejected, it allows to rinse the excretory ducts and “tanks” of the mammary gland, freeing them both from part of the metabolites and from dead microorganism cells, and further reduces the likelihood of the child becoming infected with staphylococci even in the first days of treatment. Thus, the claimed combination of actions allows to increase the effectiveness of rehabilitation and to avoid the need to cancel breastfeeding until the end of the course of rehabilitation. In addition, the use in the proposed method as a medicine of microorganisms inherent in the normal microflora of the human intestine, with physiologically sound additives that are harmless to the body in combination with the dosages and modes of administration developed by the inventors, leads to the absence of negative effects on the body of the nursing mother as a whole, and on microbial homeostasis of the mother and child.

The method is as follows. Before the procedure, the breast is washed with warm boiled water and wiped dry. A relaxing breast massage is performed. In this case, the breast is stroked with the palm of the hand at a slow pace (approximately 10-20 touches per minute) clockwise, bypassing the areola, for approximately 1-3 minutes (until a slight hyperemia of the skin surface and temperature increase by 0.3-0, 5 ^o C). Then rub the palm of the breast at the same pace clockwise for approximately 2-5 minutes (until severe hyperemia of the skin surface and increase in skin temperature by 0.5-0.7 ^o C). A suspension of 2.5-6.5 hours culture of bifidobacteria or lactobacilli at a concentration of 10 ⁷ -10 ⁹ cells in 1 ml containing 1-8 wt.% The protective environment N 1 (skimmed milk powder) or N 2 (72-90% lactose, 2-6% dextran, 2-6% thiourea and 2-6% ascorbic acid), or a suspension of resuspended microbial cells obtained by dissolving ready-made dry preparations - bifidumbacterin or lactobacterin in water (based on 2.5-5 doses of the drug 5 ml of boiled water) moisten a 4-layer gauze napkin (sterile) in the form of a circle with a surface value for a single use 0.1-0.3 dm ² . The choice of the dose of the drug within the stated range of values is carried out individually depending on the level of microbial contamination of breast milk, the immunological reactivity of the body (according to clinical manifestations) and the integrity of the skin of the nipple and areola. A napkin impregnated with a suspension of microbial cells (1–2 min after massage) is applied to the nipple and areola of the mammary gland in the form of applications, firmly pressing it to the surface of the chest. Compressor or wax paper can be applied over the napkin and secured with a bandage around the torso. The exposure of the application is 30-40 minutes. After removing the napkin, the breast is dried for 1-3 minutes and a tonic massage of the breast is performed. In this case, the breast is gently stroked with the palm of the hand at an average pace (with a frequency of approximately 25-40 touches per minute) clockwise for approximately 0.5-2 minutes (until mild hyperemia of the skin surface and skin temperature increase by 0.7 - 0.9 ^o C): then - rubbing the palm of the breast of the breast clockwise at the same pace for about 2-5 minutes (until severe hyperemia of the skin surface and increase in skin temperature by 0.9-1.2 ^o C); and finally, kneading the mammary gland with two palms clockwise at the same pace until the first portion of milk appears (for approximately 2-7 minutes). After the massage, the chest is rinsed with warm boiled water and wiped dry. The procedure is carried out 2 times a day (morning and evening) immediately before feeding the baby. The duration of the rehabilitation course is 5-7 days.

 The invention is illustrated by the following examples.

 Example 1

 Nursing mother S., 26 years old. Child Sasha S., 2.5 months, was in the intestinal infections department of the Children's City Infectious Hospital No. 3 of St. Petersburg with a diagnosis of Salmonella. Received natural feeding.

During bacteriological examination of mother’s breast milk for the presence of UPM, which was performed according to generally accepted methods / 2 /, S. aureus was isolated. The seeding mass was 8 • 10 ⁷ CFU / ml.

Reconstruction of the mother was carried out using the claimed method. In this case, before the procedure, the breast was washed with warm boiled water and wiped dry. We performed a relaxing breast massage, including: stroking the breast with a palm at a slow pace (12 touches per minute) clockwise, bypassing the areola, for 2.5 minutes; rubbing with the palm of the breast at the same pace clockwise for 3 minutes A suspension of 4-hour culture of B. bifidum 791 at a concentration of 10 ⁷ cells / ml, containing 1 wt.% Protective medium N 1, was moistened with a 4-layer sterile gauze in the form of a circle with a surface size for a single use of 0.1 DM ² . A napkin impregnated with a suspension of microbial cells was placed (1 min after massage) on the nipple and areola of the mammary gland in the form of an application, firmly pressing it to the surface of the chest. Compressor paper was applied over the napkins and secured with a bandage around the torso. The exposure of the application was 30 minutes. After removing the wipes, the breast was dried for 1 min, after which a tonic massage of the breast was performed. In this case, the breast was stroked sequentially with the palm of the hand at an average pace (with a frequency of 30 touches per minute) clockwise for 1.5 minutes, then rubbing the breast with the palm of the breast clockwise at the same pace for 2 minutes; and finally, kneading the mammary gland with two palms clockwise at the same pace for 2.5 minutes (until the first portion of milk appears). After the massage, the chest was rinsed with warm boiled water and wiped dry. Immediately after the end of the procedure, the baby was fed. The procedure was carried out 2 times a day (morning and evening) for 7 days. During the entire course of rehabilitation, the child received natural feeding.

 During repeated bacteriological examination of breast milk (after the completion of the rehabilitation course), S. aureus seeding was less than 250 CFU / ml (i.e., in accordance with the Methodological recommendations / 2 / was within normal limits). The child had an improvement in general condition, a decrease in intoxication, and normalization of stool. Complications, side effects in the mother and child were not noted.

 Example 2

 Nursing mother K., 28 years old. The child Venya K., 8 months old, was in the intestinal infections department of Children's State Children's Hospital No. 3 with a diagnosis of Sonne dysentery. Received natural feeding.

In a bacteriological study of mother's breast milk, S. aureus was isolated, the seeding mass was 1 • 10 ⁶ CFU / ml.

Maternal sanitation was carried out using the inventive method analogously to example 1. A relaxing massage was carried out in the following mode: stroking the mammary gland with a frequency of 15 touches per minute for 2 minutes: rubbing it at the same pace for 3 minutes. For applications, a suspension of a 6-hour B. bifidum N 791 culture was used at a concentration of 10 ⁸ cells / ml containing 8 wt% of the protective medium N 1. The surface area of the gauze cloth was 0.3 dm ² . Exposition of applications 40 min. After removing the wipes, the breast was dried for 2 minutes. Toning massage was carried out in the following mode: stroking the mammary gland with a frequency of 35 touches per minute for 2 minutes; grinding - at the same pace for 3 minutes; kneading the mammary gland at the same pace for 4 minutes (until the first serving of milk appears). The duration of the rehabilitation course is 6 days.

 Upon repeated bacteriological examination of breast milk (after the completion of the rehabilitation course), sowing of S. aureus was 230 CFU / ml (within normal limits). The child observed improvement in general condition, decreased intoxication, normalization of stool. Complications, side effects in mother and child were absent.

 Example 3

Nursing mother S .. 25 years old. Child Ira S., 2 months old, was in the intestinal infections department of Children's State Children's Hospital No. 3 with a diagnosis of Salmonella. Received natural feeding. Results of a bacteriological study of breast milk: S. aureus was isolated, the seeding mass was more than 5 • 10 ⁴ CFU / ml.

The mother was rehabilitated using the inventive method analogously to example 1. Relaxing massage: stroking the mammary gland with a frequency of 10 touches per minute for 2 minutes; grinding - at the same pace for 3 minutes For applications, we used a mixture of resuspended microbial cells obtained by dissolving the finished dry bifidumbacterin preparation in water (manufacturer: Biomed Scientific and Production Association, Immunogen concern, Perm) at the rate of 2.5 doses of the drug per 5 ml of boiled water. The surface area of the gauze cloth 0.2 dm ² . Exposition of applications 30 min. After removing the wipes, the breast was dried for 2 minutes. Toning massage: stroking the mammary gland with a frequency of 25 touches per minute for 1.5 minutes; grinding - at the same pace for 2.5 minutes, kneading - at the same pace for 7 minutes (until the appearance of the first portion of milk). The duration of the rehabilitation course is 7 days.

 In a second bacteriological examination of breast milk (after the completion of the rehabilitation course), S. aureus seeding was less than 250 CFU / ml (within normal limits). The child had an improvement in general condition, a decrease in intoxication, and normalization of stool. Complications, side effects in mother and child were absent.

 Example 4

 Nursing mother F., 36 years old. A child of Gena F., 3 months old, was hospitalized at the Children's Infectious Diseases Clinic of the St. Petersburg State Pediatric Medical Academy. Diagnosis: Flexner dysentery. Being in the clinic, he received natural feeding.

Results of bacteriological examination of mother’s breast milk: S. aureus was detected in an amount of more than 1 • 10 ⁷ CFU / ml.

The mother was rehabilitated using the claimed method analogously to example 1. Relaxing massage: stroking the mammary gland with a frequency of 20 touches per minute; grinding - at the same pace for 4 minutes For applications used a suspension of resuspended microbial cells obtained by dissolving 5 doses of bifidumbacterin dry as in example 3. The surface area of the gauze cloth 0.3 dm ² . Exposition of applications 40 min. After removing the wipes, the breast was dried for 1 min. Toning massage: stroking the mammary gland with a frequency of 35 touches per minute for 2 minutes: rubbing - at the same pace for 4 minutes: kneading - at the same pace for 3 minutes (until the first serving of milk). The duration of the rehabilitation course is 6 days.

 Upon repeated bacteriological examination of breast milk (after the completion of the rehabilitation course), sowing of S. aureus was 215 CFU / ml (within normal limits). The child had an improvement in general condition, a decrease in intoxication, and normalization of stool. Complications, side effects in the mother and child were not noted.

 Example 5

 Nursing mother L., 40 years old. The child Fedya L., 3 months old, was admitted to the department of intestinal infections DGIB N 3 with a diagnosis of Acute intestinal infection of unknown etiology. From the anamnesis it is known that 2 months ago the mother was treated in a hospital with a diagnosis of Purulent mastitis. Vulvovaginitis. A course of ampicillin trihydrate (10 days orally) and brilliant green (topically) was given. Discharged with clinical recovery.

During bacteriological examination of mother's breast milk, S. aureus was isolated in an amount of 1 • 10 ⁹ CFU / ml.

The mother was rehabilitated using the inventive method analogously to example 1. Relaxing massage: stroking the breast with a frequency of 18 touches per minute for 3 minutes; grinding - at the same pace for 5 minutes For applications, a suspension of resuspended cells obtained by dissolving the finished preparation of dry lactobacterin in water (manufacturer: Gorky Research Institute of Epidemiology and Microbiology, Gorky) at the rate of 2.5 doses of the drug per 5 ml of boiled water was used. The surface area of the gauze cloth 0.3 dm ² . Exposition of applications 40 min. After removing the wipes, the breast was dried for 1 min. Toning massage: stroking the mammary gland with a frequency of 40 touches per minute for 0.5 minutes; grinding - at the same pace for 1 min; kneading of the mammary gland - at the same pace for 5 minutes (until the appearance of the first portion of milk). The duration of the rehabilitation course is 7 days. During the course of rehabilitation, the child received natural feeding.

 Repeated bacteriological examination of breast milk (after a course of rehabilitation): no growth of S. aureus colonies. The child noted a slight improvement in well-being, decreased intoxication, and decreased stool from 8 to 5 times a day. Complications, side effects in the mother and child were not observed.

 Example 6

 Nursing mother P., 23 years old. The child of Gene P., 4 months old, was in the intestinal infections department of Children's State Children's Hospital No. 3 with a diagnosis of Dysentery clinically.

Bacteriological examination of mother’s breast milk showed the presence of S. aureus, the seeding mass of 5 • 10 ³ CFU / ml.

Mother sanitation was carried out using the inventive method analogously to example 1. Relaxing masses: stroking the mammary gland with a frequency of 10 touches per minute for 1 minute, rubbing it at the same pace for 2 minutes. For applications, a suspension of resuspended microbial cells obtained by dissolving 5 doses of dry lactobacterin as in Example 5 was used. The surface area of the gauze cloth was 0.1 dm ² . Exposition of applications 30 min. Drying the breast for 2 minutes. Toning massage: stroking the breast with a frequency of 25 touches per minute for 0.5 minutes; grinding - at the same pace for 3 minutes; kneading of the mammary gland - at the same pace for 3.5 minutes (until the appearance of the first portion of milk). The duration of the rehabilitation course is 5 days.

 Repeated bacteriological examination of breast milk after a course of rehabilitation: sowing of S. aureus was less than 250 CFU / ml. The child had an improvement in general condition, a decrease in intoxication, and normalization of stool. Complications, side effects in the mother and child were not noted.

 The claimed method was used for the rehabilitation of 107 practically healthy women aged 17 to 40 years with a massive contamination of breast milk S. aureus in excess of 1000 CFU / ml. Moreover, in 42 women, sanitation was carried out using bifidumbacterin, and in 65 women using lactobacterin. Remediation of lactating bacteriocarrier mothers was carried out at the Children's Infectious Diseases Clinic of the St. Petersburg State Pediatric Medical Academy and the Children's City Infectious Hospital No. 3 of St. Petersburg. The effectiveness of rehabilitation was assessed by bacteriological examination of breast milk for staphylococcus before and after the course of rehabilitation. Isolation and identification of staphylococcus culture was carried out according to standard methods / 2 /. The result of the rehabilitation was regarded as positive with a decrease in the seeding rate of S. aureus breast milk to less than 250 CFU / ml in accordance with the Methodological Recommendations / 2 /. In addition, the presence or absence of complications and side effects in patients undergoing rehabilitation was taken into account. Due to the fact that during the entire rehabilitation course by the claimed method, the breastfeeding was not canceled, the presence or absence of indirect negative effects of the procedure on the child's body was also evaluated.

 The comparison group consisted of 43 women aged 17 to 37 years, treated with oxacillin sodium salt. The antibiotic was administered orally at a therapeutic dose of 0.5 g 4 times a day for 5 days / 6 /. During the treatment period, breastfeeding was stopped.

 The results are presented in table 2.

 From the data of table 2 it can be seen that the application of the claimed method ensures the achievement of a positive result of rehabilitation in an average of 88.8% of cases in the absence of any complications in nursing mothers. At the same time, in the process of rehabilitation by the claimed method in children with intestinal manifestations of staphylococcal infection (stool dysfunction, pathological impurities, indigestibility), in a number of cases, an improvement in general condition, a decrease in intoxication, and normalization of intestinal functions were observed. No complications and side effects of rehabilitation in children were noted.

 When using oxacillin for antibiotic rehabilitation with an efficiency comparable to the claimed method (88.4% on average), patients experienced complications in the form of allergic reactions, nausea, intestinal dysfunction in an average of 20.9% of cases.

 Thus, the claimed method of rehabilitation, providing high efficiency, also meets physiological and environmental criteria, because it functions within the framework of modern medicine and ecology (in particular, requirements regarding the need to reduce xenobiotic loads on people).

Sources of information
1. Staphylococcal infection with intestinal lesions in children of the first months of life: epidemiology, diagnosis, clinic, treatment. Methodical recommendations (Ministry of Health of the USSR, Ch. Exercise. Medical-prophylactic. Assistance to children and mothers). - M .: Mosk. reg. n-a clinic. Institute, 1985.- p. 3-4, 20
2. Methodological recommendations for bacteriological control of breast milk (Ministry of Health of the USSR, Ch. Exercise. Treatment - prophylactic help for children and mothers) .- M.: B.I., 1984.- 31 p.

3. Budagovskaya S. N., Shutova A. P., Mordvinova N. B. and other Epidemiological evaluation of microbial contamination of breast milk of healthy women // Journal of Microbiology, Epidemiology and Immunobiology.-1984.-N 10.- p. 79-82
4. Reference neonatologist / Ed. Tabolin. N.P. Shabalova.-L.: Medicine, 1984.- p. 32
5. Handbook of the use of bacterial and viral drugs / Ed. S. G. Dzagurov and F.F. Rezepova.- M .: Medicine, 1975.- p. 110-111, 113-116, 161-163, 168-170 (prototype)
6. Mashkovsky M. D. Drugs. In two parts. Part II - 12th ed. , reslave. and additional ..- M .: Medicine, 1993.- p. 254-255, 257, 262-264, 308-309
7. Steinier P., Edelberg E., Ingram J. World of microbes. In three volumes. / Per.s English / - M.: Mir. 1979.-vol. 1, p. 35. t.2, p. 42-44, 69-87, 308
8. Markova I.V., Shabalov N.P. Clinical pharmacology of newborns. - L .: Medicine, 1984.- P.233
9. Treatment and prevention of dysbacteriosis in children: Method.recommendations (Ministry of Health of the USSR, Ch. Exercise.- prophylactic. Care for children and mothers: / comp. Dorofeychuk V.G. et al ./- M .: B .. .. 1986.- p. 8
10. Catalog of dry microbiological culture media. - Makhachkala: NPO "Culture media", 1992.-p.5
11. Krasnogolovets V.N. Intestinal dysbiosis. - 2nd ed. reslave. and add. - M .: Medicine, 1989.- p. 7-12
12. Pshenichnov P. A. Kolotov V.M. Barikhin S.Ya. et al. On the existence of a system of specific autometabolic regulation of the development of microbial populations. The first observations on the identification of an autofactor that stimulates the development of cultures .- // Ecology, - 1975.- N 3- p.42-50
13. USSR author's certificate N 1638156, C 12 N 1/00, 1/38, 1991, Bull. N 12
14. Andreev BC, Gorshenina E.S., Dronova N.V., et al. Electroadaptation of microorganisms to stressful effects. - // Biotechnology, - 1986.- N 6.- p. 41-47
15. Application N 93008942/13 of 02.17.93. C 12 N 1 / 38-

Claims (11)

1. A method of sanitizing women with massive microbial contamination of breast milk, including applying the drug to the affected area, characterized in that before applying the drug, a relaxing massage of the breast is performed for 3-10 minutes, a suspension of microorganisms of normal intestinal microflora is used as the drug containing an additional 1-8 wt.% microbiological protective film-forming medium, and the application of the suspension is carried out on the nipple and areola mo internal gland with exposure to 30-40 min in dosages that will provide a concentration of cells of microorganisms for at least 10 ⁶ cells per cm ² skin, after which the surface of the skin is dried, and the readjustment procedure is performed two times a day for 5-7 days.  2. The method according to claim 1, characterized in that use microorganisms located in the active phases of growth.  3. The method according to claims 1 and 2, characterized in that bifidobacteria are used as microorganisms of the normal intestinal microflora.  4. The method according to claims 1 and 2, characterized in that lactobacilli are used as microorganisms of the normal intestinal microflora.  5. The method according to claims 1 to 4, characterized in that skimmed milk powder is used as a protective film-forming medium.  6. The method according to claims 1 to 4, characterized in that as a protective film-forming medium using a medium containing 72-90% lactose, 2-6% dextran, 2-6% thiourea and 2-6% ascorbic acid.  7. The method according to claim 1, characterized in that a suspension of eubiotics is used as a suspension of microorganisms of normal intestinal microflora containing a protective film-forming medium.  8. The method according to claim 7, characterized in that bifidumbacterin is used as eubiotics.  9. The method according to claim 7, characterized in that lactobacterin is used as eubiotics.  10. The method according to PP.8 and 9, characterized in that eubiotics are administered in an amount of 2.5-5 doses of the drug.  11. The method according to claims 1 to 10, characterized in that after drying the surface of the skin an additional tonic massage of the breast is performed.

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