MONITORING OF ANAEROBIC PATHOGENS RESISTANCE IN PATIENTS WITH SURGICAL SKIN AND SOFT TISSUE INFECTIONS

Background: The problem of treating anaerobic infections in surgery continues to be relevant. Aim: To develop a protocol for empirical antibiotic therapy of anaerobic infection in patients with surgical skin and soft tissue infections. Material and methods: A total of 191 patients were examined. Identification and assessment of pathogens sensitivity was performed on the АТВ Expression analyzer. In addition, we used the ID-ANA and AB-AN test systems, developed by us. Results: In the structure of anaerobes, bacteroids, peptococci and peptostreptococci continue to occupy the leading positions. No changes in the resistance of anaerobes to most antibiotics were found. There is an increase in the resistance of peptococci and peptostreptococci to clindamycin. Metronidazole, imipenem, meropenem retain high activity. Conclusions: If anaerobic infection is suspected, it is recommended to prescribe metronidazole, and imipenem and meropenem as reserve drugs.

Use of ornidazole in the treatment of anaerobic infection in surgery

One of the most complex problems of modern surgery is the treatment and prevention of anaerobic infection. Main place in overcoming of this infectious complication is devoted to urgent surgical intervention and correct early empiric antibacterial therapy. Special place in the combined empiric antibacterial treatment is devoted to 5-nitroimidazoles. Modern data about clinical efficacy of ornidazole in the treatment of surgical infectious complications is presented in the article. We performed a comparison of therapeutic activity and physical-chemical properties, pharmacokinetic and pharmacodynamic features of ornidazole with the first representative of 5-nitroimidazole class – metronidazole. Taking into account antiprotozoal and antianaerobic activity of ornidazole, it is recommended to be used in the schemes of combined therapy of severe generalized anaerobic infections and purulent processes of different localization; treatment and prevention of surgical infections after intraabdominal, thoracic, proctological and dental surgical interventions.

Pelvic actinomycosis: a forgotten cause of pelvic pain

Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6–12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.

Anaerobic bacteria

Anaerobic bacteria will not grow when incubated with 10% CO2 in room air, but they vary in their tolerance of different levels of oxygen. Anaerobic bacteria are important commensal flora of the skin and oral, intestinal, and pelvic mucosae, and are classified according to their Gram-staining characteristics and ability to produce spores: (1) Gram-positive—cocci, non-spore-forming bacilli, and spore-forming bacilli (notably the Clostridium spp.); (2) Gram-negative—cocci and bacilli. Many anaerobic bacteria possess virulence factors that facilitate their pathogenicity (e.g. histolytic enzymes and various toxins). A putrid odour of the affected tissue or drainage is highly suggestive of an anaerobic infection, as is the presence of gas in tissues. Aside from supportive care, treatment requires drainage of abscesses and resection of devitalized tissue; and antibiotics—agents that are active against anaerobes include clindamycin, metronidazole, vancomycin, β‎-lactam/β‎-lactamase inhibitor combinations, carbapenems, moxifloxacin, tigecycline, chloramphenicol, and even macrolides.

Diagnostic features of artificial pyoinflammatory diseases of soft tissues

The objectiveof the article is to discuss diagnostic peculiarities of artificial pyoinflammatory diseases of soft tissues (APIDST).Material and methods.We analyzed the clinical data of 302 military men.Results.As compared to the non-artificial pyoinflammatory diseases of soft tissues of level 2-4 (PIDST of level 2-4), APIDST are characterized by the presence of local self-induced skin injuries that are mostly located on shins, the crepitation during palpation in the projection of the abnormal focus, and the signs of anaerobic infection (86.1%) and cellular-fascia-myositis (57.6%) during the surgical intervention in the lesion.Conclusion.The revealed clinical features of pathology should be taken into account in the treatment.