Микробный пейзаж пролежней у больных с тяжелыми травмами центральной нервной системы

Abstract

Research goal. To investigate the incidence of pressure ulcers and the structure of bacterial pathogens in young patients who have suffered severe trauma to the brain or spinal cord. Materials and methods. The prospective observational study included 69 patients who had suffered a severe brain or spinal cord injury within 3 to 9 months prior to admission to the hospital. During the stay in the hospital, a microbiological study of biopsy specimens obtained during the surgical treatment of pressure ulcers was regularly carried out. Results. All study participants were male. The age of the patients included in the study ranged from 19 to 52 years, mean – 31.4±7.8 years. Pressure ulcers were observed in 37 of 69 patients (53.6%). Initially, microbiological examination most often revealed Pseudomonas aeruginosa – 13 patients (35.1%), Staphylococcus aureus – 11 (29.7%), Enterococcus faecalis – 7 (18.9%), Proteus mirabilis – 5 (13.5%), Klebsiella pneumoniae – in 4 (10.8%), Acinetobacter baumannii – in 1 (2.7%). In total, 62.2% of patients were prescribed antibiotic therapy for the treatment of infected pressure ulcers, 37.8% did not receive antibiotic therapy or antibiotics were prescribed only for the purpose of perioperative antibiotic therapy (during plastic closure). Along with traditional therapy, 20 patients (54%), after necrectomy, were given a vacuum-asssisted dressing, from 1 to 7 sessions, lasting from 3 to 7 days. Against the background of the therapy, in 21 cases it was possible to achieve complete elimination of microorganisms, especially when infected with P. aeruginosa. During inpatient treatment, only two patients had the same microflora in pressure ulcers (S. aureus), other patients registered superinfection. In 15 patients accession of Enterococcus spp. was observed (1 has extremely resistant strains, 1 has polyresistant strains). In 10 patients, infection with K. pneumoniae was registered (in 3, extremely resistant strains, in 4, polyresistant, in 1, pan-resistant), in 9 – Proteus spp. (in 6 – extremely resistant strains, in 1 – pan-resistant, in 1 – multi-resistant), in 6 – S. aureus (in 4 – multi-resistant strains), in 3 – Escherichia coli (susceptible strains), in 3 – A. baumannii (in 2 – pan-resistant strains, in 1 – multi-resistant strains). During inpatient treatment, autodermoplasty was performed in 14 patients (37.8%), in 13 of these cases it was successful. Conclusion. The results of a pilot study indicate the effectiveness of combination therapy with antibacterial drugs and VAC-therapy in young patients with infected pressure ulcers caused by severe injuries of the central nervous system.