Rational antimicrobial therapy and wound healing stimulation in patients with surgical infection

Abstract

The objective of the study was to develop the problem of complex treatment of surgical infections of the skin and soft tissues (SISST).The studies were carried out in 201 patients with SISST who were treated at the Department of Purulent Surgery of the Hospital Surgery Clinic of the EE “Vitebsk State Medical University” in 2017–2020. As a result, it was developed: a protocol for a rational use of antibiotics in the patients with SISST, an effective regimen for use of antiseptic drugs, a method for treating purulent wounds with autologous bone marrow aspirates.For 13 years, there have been significant changes in the etiological structure of gram-negative problematic pathogens in patients with purulent wounds. The share of K.pneumoniae increased approximately 8 times (by 12.25 %; p < 0.05), and A.baumannii ‒ 9 times (by 14.69 %; p < 0.05). The share of MRSA remained virtually unchanged. The resistance of problem microorganisms to almost all antibacterial drugs significantly increased. For MRSA-induced SISST, glycopeptides (vancomycin) should be recommended as a drug of choice, and oxazolidinones (linezolid) and glycylcyclines (tigecycline) should be recommended as a reserve; K. pneumoniae ‒ colistat and tigecycline; P. aeruginosа ‒ carbapenems (doripenem) and colistat; A. baumannii ‒ penicillins or cephalosporins with sulbactam (ampicillin + sulbactam) and colistat.It was found that septomyrin and 0.02 % chlorhexidine bigluconate have the greatest activity against the leading representatives of the microflora of purulent wounds. With a combined use of septomirin and chlorhexidine, the bacterial contamination of wounds decreased below the critical level already on the 2nd day after surgical treatment (p < 0.01).To stimulate wound healing, sternocentesis is performed and automyeloaspirate is taken. The curettage of the wound and the aspirate introduction into the wound edges and the application to the wound surface are performed. It has been established that, along with the pelvic bones, the sternum can be an alternative source of red bone marrow. The myeloaspirate volume obtained by sternal puncture varied from 10 to 140 ml. The developed method allows us to reliably reduce the duration of the 2 phase of the wound process by 7 days (р < 0.01).