Features of the Microbial Landscape in Patients with Generalized Peritonitis during Programmed Staged Surgical Sanitations of the Abdominal Cavity

I.V. Ioffe, V.V. Liesnyi

Abstract


The aim of the study: to establish the feasibility of the use of adapted bacteriophages in combined treatment of patients with gene­ralized peritonitis. Materials and methods. The research is based on the analysis of treatment outcomes of 65 patients. All patients were ope­rated urgently according to protocols of providing emergency surgical care. For comparative analysis, patients were divided into 2 groups. In the main group of patients, for sanitation of the abdominal cavity and selective intestinal decontamination we used adapted selective polybacteriophages (pyobacteriophage polyvalent, intesti-bacteriophage, bacteriophagum coliproteicum). Bacteriological analysis was subjected to discharge by nasointestinal tube, peritoneal exudate from the abdominal cavity. Results and discussion. The initial level of bacterial contamination in patients of the main and control groups was the same. The number of species ranged from 3 to 9. In patients in the control group, the percentage reduction of the microbial flora seeding has been slow. If the inflammatory process in the abdominal cavity failed to stop for 1–2 sanitation of the abdominal cavity, during sanitation 3–4 the infection is caused by associations of microorganisms. If in bacterial seeding of the peritoneal exudate at the primary surgery or the first sanitation E.coli, Enterococcus spp., Proteus spp. dominated, then during sanitation 3–4 Acinetobacter spp., P.aerиginosa, K.pneumoniae prevailed in the seeding. Antibiotic resistance of the isolated strains of microorga­nisms changed too. The study of the exudate of the abdominal cavity in patients of the main group showed in the dynamics that only 5 patients had changes in the initially selected species of the microbial flora and its sensitivity to antibiotics on the days 3–4 after surgery. In the main group of patients who were applied intracolonic introduction of adapted bacteriophages, we have marked a reduction of bacterial contamination of the abdominal cavity and normalization of the microflora of the small intestine on days 4–5 of the postoperative period. By day 5, in the main group in 100 % of patients we hadn’t noted the growth of pathogenic microorganisms from the small intestine and lavage fluid from the abdominal cavity, in the control group, if the treatment and staged sanitations failed, on the background of systemic antibacterial therapy we have detected a sharp increase in the number of bacteria in peritoneal exudates in 3 patients. Conclusions. During staged treatment of acute generalized peritonitis with each subsequent surgery there is a shift of the microbial landscape of peritoneal exudates in the direction of microbial associations and the substitution of community-acquired strains with antibiotic-resistant hospital ones.


Keywords


peritonitis; bacteriophage; syndrome of enteral in­sufficiency

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DOI: https://doi.org/10.22141/1997-2938.1-2.28-29.2015.80865

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