Study of etiology and antibiotic sensitivity of leading pathogens of postoperative infectious complications

Abstract

Summary. The problem of treatment and prevention of postoperative purulent complications in abdominal surgery in our time remains extremely urgent. This is due to an increase in the number of complex operations using modern technologies, an increase in the volume and duration of surgical interventions, as well as current antibiotic resistance problems. Objective: to study the structure of the leading causative agents of perioperative infectious complications in patients with surgical pathology and study their antibiotic sensitivity. Materials and methods - 576 patients, the average age of 45 ± 10.5 years, took part in the investigation, who were treated in the departments of surgery and intensive care unit of medical institutions of Vinnitsa region. A microbiological study of materials collected from patients was carried out (selection of secretions, fluid during drainage of superficial and deep surgical wounds). From the obtained biological material, a pure culture of the pathogen was isolated with its identification by morphological, tinctorial, cultural and biochemical properties according to generally accepted microbiological methods and using the Vitec automatic bacteriological analyzer (France). And a comparison was made of the profile of the sensitivity of the most significant pathogens to modern antibiotics. Results. According to the results of the study, it was revealed that the most common pathogens of surgical wound infections include opportunistic bacteria E.coli (22.0 %), S.aureus (19.0 %), S.epidermidis (13.0 %), E .faecalis (15 %), P.aeruginosa (10.0 %), A.baumanii (11.3 %). An analysis of the sensitivity to antibiotics of various classes of studied strains of the dominant causative agents of perioperative infectious complications showed that β-lactam antibiotics (meropenem (75–100 %), cefepime (65–100 %) and fluoroquinolones chemotherapeutic agents had the greatest antimicrobial activity. A slightly lower antimicrobial activity was found for third generation cephalosporins (70–85 %), amoxicillin-clavulanate (40–75%), aminoglycosides (tobramycin – 80 %, amikacin – 40 %). A high level of resistance of most grams of (-) microorganisms to ampicillin-sulbactam, cephalosporins of I–II generations in different ratios was determined. S.aureus resistance to azithromycin, clarithromycin is shown. Conclusions: the high prevalence of multiresistant isolates of pathogens (gram-positive (Staphylococcus aureus, enterococci), gram-negative pathogens (Escherichia, Klebsiella, enterobacteria, acinetobacteria, pseudomonads) emphasizes the need for dynamic microbiological monitoring in the surgical departments and the use of alternative antimicrobial drugs only.