Bacterial Factors and Ways for Optimization of Treatment Program in Patients with Acute Appendicitis
Keywords:acute appendicitis, exudate from the abdominal cavity, microflora
Introduction. Despite the advances in patients with acute appendicitis surgical treatment, the complication rate still remains significant (from 0.4 to 8.5 %), and the searching for the methods, which could concur optimizing of the medical diagnostic program remains a topical issue for an urgent abdominal surgery. Diagnostic techniques and supervision of patients with acute appendicitis (AA) are mainly based on physical examinations.
Materials and methods. Results of surgical treatment in 104 patients with acute appendicitis, carried out in the surgery department of faculty of postgraduate education in Lviv national medical university named after Danylo Galytsky, on the basis of City community clinical emergency hospital in Lviv in terms of 2003, 2006 and 2011 have been analyzed. According to the purpose of the study results of 104 bacteriological studies of exudate from the abdominal cavity in 16 patients in 2003, 31 patients in 2006, and 57 patients in 2011 have been analysed.
Results and discussion: bacteriological studies have shown that among 47 patients (2003 and 2006) with AA during the bacteriological examination of peritoneal exudate, in most cases, the growth of conditionally pathogenic and pathogenic microflora was confirmed. Conditionally pathogenic flora predominated: Escherichia coli in association with Enterobacter aerogenes, Proteus spp. and Citrobacter spp. in 2003 — 50 % (8 cases), and with Pseudomonas aeruginosa, Proteus morganii and Enterobacter aerogenes in 2006 — 12 (37.5 %) respectively. The rate of associations with Staphylococcus epidermidis and Staphylococcus aureus did not predominate by 3 %. Association of conditionally pathogenic Escherichia coli in 2011 was 46.4 % (26 cases). Among the associated flora Pseudomonas aeruginosa, Streptococcus faecalis, and Proteus vulgaris predominated.
Conclusions. 1. Conducted bacteriological examinations of exudate in patients with acute appendicitis enabled to state that the main microflora is Escherichia coli both in a monoculture, and in the form of microbial associations. 2. In determining the sensitivity of obtained culture Escherichia coli (in terms of 2003, 2006, 2011) the significant increase in resistance to cephalosporins of 3rd generation and fluoroquinolones has been confirmed, the sensitivity to drugs of carbapenems and cephalosporins of 4th generation group also increased. 3. Including into the inspection standards of patients with suspected AA sampling of exudate from the abdominal cavity for bacteriological examination helps to optimize the treatment program in patients with acute abdominal pathology.
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