Бак. посев отделяемого вагинального содержимого на микрофлору с определением чувствительности к антибиотикам

Vaginal culture with antibiotic susceptibility testing (vaginal microbiocenosis assessment) is used to characterize dysbiosis of the vaginal flora, identify the causative organism of infectious inflammation, and guide targeted antimicrobial therapy. The test supports diagnosis of nonspecific bacterial vaginitis/vulvovaginitis, bacterial vaginosis, and candidal vulvovaginitis, and can assist in evaluating infections that extend to the pelvic organs.

The vaginal microbial ecosystem comprises resident (obligate) and transient organisms that maintain colonization resistance and limit overgrowth of conditionally pathogenic species. In healthy women of reproductive age, total vaginal bacterial load typically reaches 10^7–10^9 CFU/mL and spans more than 40 species, with predominant Doderlein rods—Lactobacillus spp. (95–98%). Although many Lactobacillus taxa can be isolated, no single species is universal; commonly recovered species include L. acidophilus, L. brevis, L. jensenii, L. casei, L. leishmanii, and L. plantarum. The community also includes gram‑positive obligate anaerobes and microaerophiles (lactobacilli, bifidobacteria, peptostreptococci, clostridia, propionibacteria, Mobiluncus), gram‑negative obligate anaerobes (Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Veillonella), and facultative anaerobes (Gardnerella, corynebacteria, mycoplasmas, staphylococci, streptococci, Enterobacteriaceae, and yeasts such as Candida). Transient organisms frequently detected in moderate amounts—up to 10^4 CFU/g—include coagulase‑negative staphylococci (especially S. epidermidis), Corynebacterium spp., Streptococcus spp., Bacteroides, Prevotella spp., and Mycoplasma hominis; Micrococcus spp., Propionibacterium spp., Veillonella spp., and Eubacterium spp. are also encountered. Less commonly (in fewer than 10% of individuals), Clostridium spp., Bifidobacterium spp., Actinomyces spp., Fusobacterium spp., Ureaplasma urealyticum, Staphylococcus aureus, Neisseria spp., Escherichia coli and other coliforms, Mycoplasma fermentans, Gardnerella vaginalis, and Candida spp. are isolated. Composition varies across the life course: before menarche and during immature ovarian function, gram‑positive cocci (coagulase‑negative staphylococci, micrococci, nonhemolytic streptococci) predominate, with occasional nonpathogenic Neisseria and corynebacteria and, less often, Escherichia coli and enterococci; with puberty, lactobacilli increase and become dominant in sexually mature girls. A decline in lactobacilli with expansion of conditionally pathogenic organisms leads to dysbiosis and may manifest as vaginitis with pruritus, burning, and abnormal discharge. Such disturbances can follow local or systemic antibiotics, cytotoxic therapy, hormonal treatment, or radiation therapy and are more likely in endocrine disorders (especially diabetes), anemia, congenital anomalies of the genital tract, contraceptive use, and immune dysfunction. Opportunistic organisms can also be present in asymptomatic women; pathogenic behavior typically reflects increased concentration, so results require correlation with clinical findings and patient-reported symptoms. Culture-based assessment of the vaginal microbiocenosis detects bacterial and fungal organisms, estimates their burden, and determines antimicrobial susceptibility. Growth on artificial media enables species identification and quantification; susceptibility is assessed by incubating the isolate with antibiotics or using antibiotic‑impregnated diffusion disks to demonstrate growth inhibition. This bacteriological approach is particularly useful for infections due to opportunists—such as urogenital mycoplasmas, yeasts, Enterobacteriaceae, Streptococcus spp., and Staphylococcus spp.—because quantitative results inform interpretation. Testing may assist in diagnosing bacterial vaginosis, nonspecific bacterial vaginitis, candidal infection, pelvic inflammatory disease, and sexually transmitted infections, and it helps avoid ineffective therapy by supporting rational antimicrobial selection. Gram‑stained microscopy of genital tract secretions is a recommended adjunct, and sexually transmitted infections should be considered early when clinical features suggest genital tract infection.