[Case of successful prevention of multiple organ dysfunctions in 74 years old patient with sepsis after Crawford surgery complicated with pleural empyema, chest wall tissues infection and osteomyelitis of ribs].

The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.

[Antibiotic resistance dynamics and isolation rate of staphylococci and enterococci from patients of reconstructive surgery units].

The dynamics of isolation of staphylococci and enterococci from clinical material of patients and their antibiotic susceptibility within a 5-year period (2005-2009) was analysed. 5990 isolates were tested: 1250 isolates of Staphylococcus aureus, 3268 isolates of S. epidermidis, 1005 isolates of Enterococcus faecalis and 467 isolates of E. faecium. Grampositive infections were shown to be prevailing within the last 2-3 years, the nosocomial epidermal staphylococci more and more replacing S. aureus (the ratio of S. epidermidis and S. aureus in 2009 was 3.3). The isolation rate of E. faecalis significantly increased (by 3.5 times) and the ratio of E. faecalis and E. faecium in 2009 was 4.3. The microflora composition with respect to the isolation source was analysed and its clinical significance was estimated. The study of the antibiotic susceptibility showed that oxacillin had its own specific niche, while antibiotics active against resistant grampositive cocci, such as rifampicin, fusidic acid, fluoroquinolones (moxifloxacin), cefoxitin, as well as amoxicillin/clavulane in infections due to E. faecalis, might be considered as the drugs of choice. In the treatment of nosocomial infections, when the etiological role of MRSA or VRE is suspected or confirmed, the complex therapy should obligatory include the most active antibiotics (vancomycin or linezolid among them).

[Nonfermentative gram-negative bacteria: isolation rates and antibiotic sensitivity].

The isolation rates of nonfermentative gram-negative bacteria (NFGNB) are analyzed in the inpatients treated at the B. V. Petrovsky Russian Surgery Research Center in 2005-2009 and antibiotic resistance trends in nosocomial strains of NFGNB are traced in the above period. The study of the etiological structure of nosocomial infections has shown that the past 2 years (2008 and 2009) were marked by a clear tendency for the preponderance of gram-positive coccal pathogens (46.8 and 53.9%) with a considerable (1.5-2-fold) reduction in the proportion of representatives of enterobacteria (31.5 and 24.5%) and NFGB (13.4 and 11.3%), but with an increase in the proportion of fungi up to 7.1 and 8.6%, respectively. Among the NFGNBs, P. aeruginosa remains ohe of the most common pathogens for nosocomial infections although its portion in the number of all etiologically significant microorganisms was substantially reduced (from 13% in 2005 to 4.6% in 2009). It continues to remain one of the most common causative agents for infections of the urinary tract (e.g., after renal transplantation) and upper and lower respiratory tract (e.g. nosocomial pneumonia) and for those developing after surgical interventions (postoperative wound suppuration discharged along the drainages, from a T-sized tube, etc.). Among the NFGNBs, Acinetobacter spp. was the second frequently isolated pathogen, the isolation rate for which also decreased from 7.9% in 2005 to 2.6% in 2009. Polymyxin B and carbapenems (imipenem, meropenem, and doripenem) showed the highest activity against the vast majority of the test strains; however, there was an absolutely clear declining trend in the proportion of carbapenem-sensitive strains among virtually all the NFGNBs under study. According to the proportion of imipenem-, meropenem-, and doripenem-sensitive nosocomial P. aeroginosa strains (66.7, 46.6, and 44.7%, respectively), doripenem had the least activity. Acinetobacter spp. strains sensitive to these drugs showed the same trend (85.1, 51.2, and 39.2%, respectively). Meropenem and doripenem were equally active against B. cepacia strains, each demonstrated 50% sensitivity. As compared with meropenem, doripenem had a preferential activity against only O. anthropi (75 and 57.1% sensitivity, respectively). All the three carbapenems were inactive against S. maltophilia.

[Dynamics of acquires resistance in the main gramnegative pathogens of surgical infections to beta-lactams in 2004-2008].

Resistance of 2134 clinical isolates of etiologically significant species of gramnegative bacteria to 5 beta-lactam antibiotics, i. e. cefepime, piperacillin/tazobactam, cefoperazone/sulbactam, imipenem and ceftazidime (the 3rd generation cephalosporin) as the reference drug was investigated for the period of 5 years (2004-2008). In total, 554 strains of E. coli, 578 strains of P. aeruginosa, 255 strains of Acinetobacter spp., 161 strains of Proteus mirabilis, 359 strains of Klebsiella pneumoniae and 227 strains of Enterobacter cloacae were assayed in dynamics. The comparative analysis of the frequency of the antibiotic resistant isolates from the patients treated within 2004-2008 with often and long-term use of cefoperazom-sulbactam, meropenem and imipenem revealed an increase in development of resistance to all beta-lactams, including the inhibitor-protected ones. It least of all concerned imipenem, still isolation of 39.5% of the imipenem resistant strains of P. aeruginosa was in favour of the tendency. A dramatic 3-5-fold rise of resistance in 2007 and 2008 in the isolates of K. pneumoniae, E. cloacae and Acinetobacter spp. to both the inhibitor-protected beta-lactams, that averaged 56 and 45%, 45 and 35% and 26 and 30% respectively, deserved attention. It was assumed that the main mechanism of resistance in the isolates to the inhibitor-protected beta-lactams was hyperproduction of beta-lactamase of type CTX-M. The large part of the cefepime resistant isolates of K. pneumoniae and Acinetobacter spp. (76.8 and 62.2% respectively) was in favour of the assumption. It was concluded that periodical reversion of the policy of preventive antibiotic prophylaxis was necessary, since such a prophylaxis is a reliable barrier to development of postoperative complications and at the same time it promotes selection of nosocomial strains with some other mechanisms of antibiotic resistance under hospital conditions.

[Antimicrobial and antimycotic therapy in the surgery of iatrogenic esophageal and tracheal diseases].

Microbiologic analysis of tracheal and gastrostomic discharge was performed in 327 patients with iatrogenic injuries of trachea and esophagus, operated during 2003-2008. Main groups of microorganisms, colonizing the tracheobronchial tree were defined. St. epidermalis was defined in 3.9-13.3%, St. aureus - in 12.4-21.1%, Ps. small a. Cyrilliceruginosa - in 9.2-17.5% of cases. Increase of Candidae colonization was revealed (7.8-12.2%). The increase of polyresistant strains identification was typical. St. epidermalis and St. aureus demonstrated the preserving high sensitivity to vankomycin and linesolide, whereas Ps. aeruginosa showed the growth of resistance to all groups of antibiotics, but polymyxin. The common decrease of antibiotic activity requires the realization of complex antibacterial and antimycotic treatment.

[Infectious complications in patients with iatrogenic diseases of the trachea and esophagus].

Methods for microbiological monitoring could analyze the microflora isolated in 372 patients with iatrogenic diseases of the trachea and esophagus, who were treated at the Department for Surgery of the Lung and Mediastinum, Acad. B. V. Petrovsky Russian Research Center of Surgery, Russian Academy of Medical Sciences, in 2003 to 2009. Major groups of microorganisms colonizing the tracheobronchial tree in patients who had undergone long-term resuscitation, injuries, surgery, etc. and in those who had admitted to the department from other clinics are identified. The main clinically significant microorganisms isolated during the pathological process in this area were Staphylococcus epidermadis (3.9-13.3%), St. aureus (12.4-21.1%), Pseudomonas eruginosa (9.2-17.5%), and Candida fungi (7.8-12.2%). This indicates the greater importance of the fungal microflora and its representatives' resistance to the most commonly used drugs. Rational antibacterial therapy regimens are proposed in relation to the type of microorganisms colonizing the tracheobronchial tree.

[Problems of prophylaxis and treatment of infectious complications in reconstructive surgery].

Infectious complications due to polyresistant staphylococci as well as strepto- and enterococci are of serious problem in reconstructive surgery, since the number of such strains isolated within 1999-2004 has amounted to 58.4-59.7% of all the isolates. Susceptibility testing of 195 isolates showed that 100% of them was susceptible to linezolid that was used in the postoperative treatment of 28 patients after reconstructive surgical operations including those with artificial circulation under conditions of a multiprofile surgical hospital. Linezolid proved to be a highly effective agent in the prophylaxis and treatment of infectious complications due to polyresistant grampositive pathogens. Step-by-step therapy with linezolid was shown possible. In the treatment of pediatric cases no side effects of linezolid were recorded.

[Cefepime treatment efficacy in surgical patients]. / Perspektivy ispol'zovaniia novogo tsefalosporinovogo antibiotika chetvertogo pokoleniia v khirurgii.

Clinical and bacteriologial efficacies of cefepime were studied in the treatment of 20 surgical patients. Intraoperative prophylaxis is with the use of cefepime alone and postoperative prophylaxis with the use of cefepime in combination with some other drugs were applied to 10 patients. No postoperative complications in the group of the 10 patients were stated. The other 10 patients were subjected to intraoperative and postoperative combined prophylaxis with some other antibiotics. In 6 patients of the latter group postoperative complications developed. Obvious clinical advantages of cefepime were demonstrated.

[Principles of prevention of pneumonia associated with the use of artificial ventilation of the lungs in resuscitation and intensive care units]. / Printsipy profilaktiki pnevmonii, sviazannoi s ispol'zovaniem iskusstvennoi ventiliatsii legkikh v otdeleniiakh reanimatsii i intensivnoi terapii.

Pneumonia ranks among the most incident complications associated with forced ventilation of the lungs (FVL). Its incidence depends on FVL duration and according to published reports varies from 9 to 70%. Pneumonia deteriorates the prognosis and essentially increases the mortality in intensive care wards. Based on published reports and their own experience, the authors formulate the fundamentals of prevention of pneumonia in patients on FVL: use of intubation tubes with low-pressure cuffs; minimum duration or no procedures involving the intubation tube cuff blowing off; regular sanitization of the tracheobronchial tree and oropharynx; use of devices for removal of tracheobronchial secretion in the closed contour and of disposable catheters; inhalation of bronchomucolytics and antibiotics through a nebulizer; patient's position in bed with elevated head part; rigid approach to prescription of antacide drugs and H2-receptor blockers; decontamination and regulation of intestinal function; antibiotic therapy with consideration for the results of bacteriological studies; no or minimum exposure to procedures involving the respiratory contour seal opening; use of sterile gloves; use of disposable respiratory contours and hydrophobic bacterial filters instead of humidifiers.

[Prevention and treatment of postoperative pyoinflammatory complications and cefuroxime]. / Profilaktika i lechenie posleoperatsionnykh gnoino-vospalitel'nykh oslozhnenii s ispol'zovaniem tsefuroksima.

Antibacterial activity and efficacy of cefuroxime (ketocef, Pliva, Zagreb) in the treatment and prophylaxis of surgical infections in a general hospital and particularly in the unit of vessel and aorta surgery, the unit of lung surgery and the unit of microsurgery were estimated. The study included 57 patients (43 males and 14 females) at the age of 21 to 70 years. Cefuroxime was administered intravenously in a dose of 1.5 g followed by its intramuscular administration in a dose of 750 mg with an interval of 8 hours. The results showed that cefuroxime was effective in the treatment (80 per cent) and prophylaxis (93.6 per cent) of the pyo-inflammatory complications and was active against the majority of the surgical infection pathogens.

[Use of ofloxacin in the treatment of suppurative-inflammatory complications in surgery]. / Opyt primeneniia ofloksatsina v lechenii gnoino-vospalitel'nykh oslozhnenii v khirurgii.

Analysis of ofloxacin use in clinical surgery over the latest decade showed that despite its wide clinical application for the prevention and therapy of postoperative complications, this drug remains highly active for the majority of micro-organisms. Hence, a wide spectrum, high bactericidal activity of the drug, optimal pharmacokinetics, and a high bio-availability (95-100%) still recommend ofloxacin, a highly effective agent for the treatment of infectious complications of surgery.

[Ten-year experience with the use of ofloxacin in reconstructive surgery]. / Desiatiletnii opyt primeneniia ofloksatsina v rekonstruktivnoi khirurgii.

The data on the use of ofloxacin in more than 300 surgical patients for the last 10 years were analyzed. The results showed that despite the wide clinical use of ofloxacin in the prophylaxis and treatment of postoperative complications the drug remained highly active against the predominating majority of microbes causing surgical infections. Therefore, the broad spectrum, high bactericidal activity and optimal pharmacokinetics with the high biovailability at the level of 95 to 100 per cent provided the use of ofloxacin as a highly efficient agent in the treatment of postoperative infectious complications in surgical inpatients.