["Evidance"--Russian national epidemiological study].

UNLABELLED: The article deals with results of epidemiological study of 2516 ICU patients received prophylaxis of a deep vein thrombosis (DVT) and venous thromboembolic complications (VTEC). RESULTS: The frequency of renal failure was 19.8%. Mortality rate in patients with acute renal failure (ARF) was 34% and in patients without ARF 17%. CONCLUSIONS: An analysis of drugs for prophylaxis of DVT and VTEC which were used in patients with ARF showed that the prophylaxis was performed without a taking in account a significance of such complication.

[Abdominal sepsis: intensive care strategy].

Sepsis is one of the most urgent problems of modern surgery as a steady tendency for the number of patients and mortality rates to increase. Sepsis is the syndrome of a systemic inflammatory response to the invasion of microorganisms. Abdominal sepsis (AS) is inherently a systemic inflammatory response to a focal of infection in the abdomen or retroperitoneal space. Implementation of an individual program for intensive care and anesthetic support is also the same important component of the program for AS treatment as surgery. Intensive care for AS is based on the objective evaluation of the patients' condition, which makes it possible not only to determine the severity of the disease and the degree of organ dysfunction, but also to choose the most adequate intensive care program in terms of a specific clinical situation. The reasonable use of currently available intensive care means and methods substantially reduce mortality rates in patients with AS.

[Efficacy of pefoxacin (abactal) in the complex treatment of patients with pancreonecrosis]. / Effektivnost' pefloksatsina (abaktala) v kompleksnom lechenii bol'nykh s pankreonekrozom.

The efficacy of pefloxacin in the complex treatment of 28 patients with pancreatonecrosis of various etiology was estimated in a prospective trial. The diagnosis of pancreatonecrosis was verified by the data of the disease clinical progress, laboratory findings and instrumental examination. Pefloxacin (Abactal; LEK) was administered intravenously in a dose of 400 mg every 8 hours (1200 mg) in combination with metronidazole in a dose of 1.5-2.0 g a day intravenously. When indicated 3 days after the start of the pefloxacin therapy, the treatment was switched to the oral use of the drug in the same dosage. The positive clinical effect (cure and improvement) at the end of the treatment with pefloxacin was stated in 78 per cent of the patients in spite of the initial severity state of above 15 APACHE II. It was shown that in the treatment of patients with pancreatonecrosis when the severity state was not above 12 APACHE II the antibacterial therapy with pefloxacin in combination with metronidazole was optimal.

[Evaluation of the effectiveness of various protocols of antibiotic prophylaxis and therapy in pancreatic necrosis]. / Otsenka éffektivnosti razlichnykh rezhimov antibakterial'noi profilaktiki i terapii pri pankreonekkroze.

The efficiency of various protocols of antibiotic prophylaxis and therapy (APT) used in 63 patients with pancreonecrosis is analyzed. Early treatment with carbapenemes is the most effective in disseminated infectious pancreonecrosis requiring obligatory surgical treatment. Drug efficiency is the key factor in choosing APT for intensive care of patients with destructive pancreatitis.

[Abdominal sepsis: the integral assessment of the severity of patient condition and of multiple organ dysfunction]. / Abdominal'nyi sepsis: integral'naia otsenka tiazhesti sostoianiia bol'nykh i poliorgannoi disfunktsii.

Results of examinations of 247 patients with diffuse peritonitis and symptoms of abdominal sepsis are analyzed. Systemic inflammatory reaction in peritonitis patients can manifest by sepsis, severe sepsis, and infectious toxic (septic) shock. The severity of systemic inflammatory reaction syndromes can be evaluated by objective scores for evaluation of clinical states (APACHE II, SAPS) and the degree of multiple organ dysfunction/failure (MODS, SOFA). Application of objective scores for evaluation of clinical states provides clinical stratification of abdominal sepsis, helps predict the disease course and outcome, and improve treatment strategy.

[The role of antibacterial prophylaxis and therapy in pancreonecrosis]. / Rol' antibakterial'noi profilaktiki i terapii pri pankreonekroze.

The research of efficiency of different antibacterial prophylactic and therapy procedures among 89 patients suffering destructive pancreatitis is presented in the article. Determined that optimized tactics of antibacterial prophylactic and therapy with using of such medicines like carbapenems have the important value in cardinal improvement of the results of multi-stage surgical and intensive treatment of the patients suffering pancreonecrosis.

[A trial of using timentin (ticarcillin/clavulanate) in treating abdominal surgical infection]. / Opyt primeneniia timentina (tikartsillin/klavulanata) v lechenii abdominal'noi khirurgicheskoi infektsii.

Efficacy of timentin was studied in the treatment of 19 patients with peritonitis of various etiology and clinical and laboratory signs of systemic inflammatory reaction characteristic of abdominal sepsis. The clinical and bacteriological effects were recorded in 84.2 and 87.5 per cent of the cases respectively. The drug was administered intravenously dropwise for 30 minutes in a dose of 3.1 g every 4 hours. The treatment course was 4-11 days. The treatment failed in 3 patients. One of them had general peritonitis of gynecological etiology. In the other no significant regression of abdominal sepsis was observed, Pseudomonas aeruginosa strains were isolated from the abdominal cavity, the antibiotic was changed, still incurable polyorganic insufficiency developed and the patient died. The third patient had perforation of the large intestine due to tumor. No adverse reactions to the use of timentin in any of the cases was observed.

[Hospital infections caused by Pseudomonas aeruginosa. Significance in intensive therapy]. / Gospital'nye infektsii, vyzvannye sinegnoinoi palochkoi. Znachenie dlia intensivnoi terapii.

The significance of P. aeruginosa as an agent of hospital infections in intensive care departments is determined by high prevalence of this microorganism, its natural and acquired resistance to antibiotics of various groups, and severity of the infection it induces. The resistance of P. aeruginosa to antibiotics is different in different regions. Among the strains isolated in Moscow in intensive care wards for newborns 9% were resistant to meropenem, 10% to amicacine, 15% to imipramine, 16% to cefepime, 37% to ceftasidime, 45% to piperacylline/tasobactam, 45% to ciprofloxacine, and 60% to gentamicin; 1.5% of these strains were resistant to all tested antibiotics. High prevalence of antibiotic resistance among P. aeruginosa impedes the choice of drugs for empirical antibiotic therapy and increases the significance of microbiological diagnosis. Even if an agent is sensitive to such antibiotics as semisynthetic penicillines and aminoglycosides, their use as monotherapy in infections caused by P. aeruginosa is ineffective. Carbapenemes, III- IV generations cefalosporines, and fluoroquinolones can be used as mono therapy.

[The efficacy of cefepime (Maxipime) in the treatment of abdominal sepsis in surgical patients]. / Effektivnost' tsefepima (Maksipima) v lechenii abdominal'nogo sepsisa u khirurgicheskikh bol'nykh.

The efficacy of cefepime in the treatment of 46 patients operated for general peritonitis of various genesis and severity (APACHE II not greater than 35) was studied. Cefepime was used in a dose of 2 g administered every 12 hours as slow intravenous infusions in 0.9 per cent sodium chloride solution in combination with metronidazole administered intravenously in a dose of 7.5 mg/kg body weight. The treatment course was 4 to 15 days. 45 patients were given diflucan for the prophylaxis of fungal superinfection, 3 patients were given aminoglycoside antibiotics (netilmicin or amikacin) and 2 patients were given vancomycin per os. The favourable clinical effect of the cefepime therapy was stated in 38 patients (82.6 per cent) including 4 out of 10 patients with initial APACHE II > 15. 101 isolates of aerobic gram-negative and gram-positive microbes from 38 patients treated with cefepime in combination with metronidazole were tested to estimate the bacteriological efficacy of the therapy and it was shown that only 5.9 per cent of them was resistant. The pathogen eradication was stated in 84.2 per cent of the patients.

[Nosocomial infections in intensive care]. / Nozokomial'naia infektsiia v intensivnoi terapii.

Nosocomial infection remains a pressing problem of surgery and intensive care. The authors analyze the sources of infection, the factors predisposing to it, and the pathogenetic aspects. The strategy of nosocomial infection control is determined by the clinical and nosological structure and severity of patients' status. Microbiological and pharmacological studies helped the authors develop the protocols of the initial and alternative antibiotic therapy of various nosocomial complications of wound infection, abdominal sepsis, nosocomial pneumonia, and infectious toxic shock. Experience gained by the authors permitted them to recommend preventive measures decreasing the risk of exo- and endogenous infection and improving the mechanisms of patients' immunity.

[Piperacillin/tazobactam in the treatment of abdominal sepsis in patients with peritonitis]. / Piperatsillin/tazobaktam v lechenii abdominal'nogo sepsisa u bol'nykh peritonitom.

Piperacillin/tazobactam (P/T) was used in the treatment of 40 patients at the age of 22 to 64 years with intraabdominal infection (peritonitis, abscesses). P/T was administered as 30-minute intravenous infusions 4 or 3 times a day for 3 to 13 days. The recovery and improvement were stated in 80 and 10 per cent of the cases respectively. In 10 per cent of the patients the treatment failed because of surgical complications or insufficient surgical intervention or because of some other systemic diseases. The pathogens in the abdominal cavity were eradicated in 31 cases. In 5 cases the pathogen eradication was followed by superinfection. No relapses or pathogen persistence were recorded. Only in 1 case Edwardsiella tarda strains resistant to P/T were isolated from the abdominal cavity discharge and P/T resistant Aeromonas hydrophila strains from the urine by the 3rd or the 5th day of the treatment. The results are in favour of P/T as a drug of choice in the treatment of surgical patients with abdominal sepsis.