The Role of Microbe Biofilm in the Pathogenesis of Complicated Forms of Chronic Anal Fissure

The problem of treatment of chronic complicated anal fissures remains one of the most important in modern proctology. To improve the treatment of chronic anal fissures, the effect of microbe biofilm on the basis of pathogenic component was studied, as the ability to form the film is an additional factor of pathogenicity of various microorganisms. Objective of the research was to study the ability of bacteria collected from chronic anal fissures (CAF) to form biofilms of various thickness for further identification of microbial sensitivity to antibacterial medicines. Results. Bacteria collected from CAF in the form of monoculture (Escherichiacoli and P. aeruginosa) formed thick biofilms in 100% of cases, whereas mixed bacterial cultures such as Escherichiacoli, P.aeruginosa, Enterococcusspp. and S.aureus formed biofilms of a moderate and high density only (about 30% and 70% of cases respectively). Most dense biofilms were formed in the mixed culture P.aeruginosa (77.4%). A comprehensive treatment of CAF should include not only antibacterial therapy against infection found in the mucous defect of the rectum, but also new methods of ethiopathogenetic influence on the biofilm of a certain density formed by the microorganisms found in CAF. The efficacy of any antimicrobial medicines should be determined according to their bactericidal action on the components of a certain microbiota. Minimal concentration inhibiting growth of planktonic cultures cannot be considered effective, but only the one affecting microorganisms as part of biofilms. Thus, in order to influence bacteria in the formed biofilms, the concentration of antibiotics in certain cases can be 10-100 times higher than planktonic forms of these bacteria. Thereby, standard antibiotic treatment eliminates planktonic cells, but it affects bacteria in biofilms less. Pathological process may begin again after completion of treatment. Conclusions. Bacteria associated in biofilms are more resistant to antimicrobial medicines and antiseptics in comparison with their planktonic forms. It allows to suggest that the ability of microorganisms collected from the mucous membrane of the anal fissures complicates antimicrobial therapy of the disease and defines its chronic development. ?