Prevention and treatment with cefoperazone of postoperative suppurative complications in heart surgery]

Clinical trials of cefoperazone (cefobid, Pfizer, USA) were carried out in 49 patients with cardiovascular diseases who had undergone surgical operations. The pathogens of infectious complications were investigated bacteriologically. Good results of the treatment were observed in 43 patients. Allergic reaction developed in 1 patient. Cefoperazone was shown advantageous in treatment of pulmonary complications in the operated patients. It was found possible to use cefoperazone in combination with aminoglycosides. Cefoperazone was found to be one of the drugs of choice in the treatment of aerobic and anaerobic bacteriemia, as well as sepsis after surgical operations on the heart and great vessels. The results on the use of cefoperazone for short-term "perioperative" prophylaxis in cardiosurgery (in accordance with the WHO instructions) are also presented.     

Use of ceftriaxone in the prevention of postoperative purulent complications after surgery on the stomach and small intestine]

Ceftriaxone was administered intravenously in a single dose of 1.0 g 15 minutes prior to surgical intervention for peptic ulcer and gastric or duodenum tumor in 31 patients at the age of 33 to 74 years. In all the patients primary adhesion of the surgical wound was recorded. No signs of local or general infection were observed. The indices of the total blood count, urinalysis and blood biochemical analysis came to normal by the 5th or the 7th day of the postoperative period. The levels of ceftriaxone in the blood, urine, stomach wall, small intestine tissues and subcutaneous fat were evaluated. The indices of the cellular and humoral immunity in the pre- and postoperative periods in the patients prophylactically treated with ceftriaxone were analyzed.     

Antibiotic prophylaxis of postoperative suppurative complications in surgical urology

Preoperative sanation of the urinary tracts is an obligatory condition for lowering the risk of severe infectious complications. When there is no bacteriuria it is recommended in the cases subject to short-term surgical interventions without subsequent drainage of the urinary tracts to perform single or one-day prophylaxis with cephalosporins or semi-synthetic penicillins in the routine doses. The same principle is applicable to transurethral operations, endourological manipulations and lithotripsy. When there are urinary fistulas preventing complete sanation of the urinary tracts before operations it is advisable to use combinations of aminoglycosides with carbenicillin. The treatment terms in such cases amount to 7 to 10 days. Antibiotics of the reserve group, i.e. amikacin, sisomicin and ureidopenicillins should not be used prophylactically in such cases.     

Use of the automated system for bacteriological diagnosis of suppurative complications

The use of the microbiological analyzer Cobas-Bact made it possible to markedly widen the possibilities of identifying pathogenic enterobacteria at the account of the species usually not detected with the routine methods. Rapid assay of antibiotic sensitivity with the Cobas-Bact system provided earlier and adequate antibacterial therapy of severe purulent complications.     

Macrolide antibiotics for oral intake in the treatment and prevention of suppurative surgical infection]

The authors studied the clinical efficacy of antibiotics of the macrolides group--erythromycin, oleandomycin, triacetylalleandomycin and leukomycin--in complex treatment of 280 patients with suppurative surgical infection caused by a gram-positive, mainly staphylococcal, microbial flora. Various medicinal forms were used: tablets, capsules, granules, syrup. Efficacy of treatment comprised 70-78 per cent. Tolerance of antibiotics was good in the majority of patients.     

Role of Pseudomonas aeruginosa in the etiology of postoperative suppurative inflammatory complications in patients with chronic suppurative lung diseases

The study of P. aeruginosa strains isolated from patients and various objects of the environment in one of the clinics of Yerevan, carried out by the methods of serotyping, pyocin typing and phage typing, has allowed the authors to establish the circulation of hospital strains and their role in the appearance of post-operative suppurative inflammatory complications in patients with chronic suppurative diseases. The study has also allowed them to reveal the sources of infection which is spread by patients serving either as its reservoirs or as intermediate hosts.     

Intralymphatic administration of antibiotics in the complex treatment of suppurative complications in patients with neurosurgical pathology

The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy.     

化脓性阑尾炎术后切口感染临床观察与预防

目的:探讨化脓性阑尾炎术后切口感染率及腹腔镜阑尾切除术(LA)后预防切口感染的措施.方法:2002年1月～2009年12月我院行阑尾切除治疗急性化脓性阑尾炎患者298例,其中209例行开腹阑尾切除术(OA),89例行腹腔镜阑尾切除术(LA),比较两种手术方式术后切口感染率,分析LA术后预防切口感染的经验.结果:术后发生切口感染21例,切口感染率为7.05%.其中腹腔镜手术组术后切口感染率为0.34%,开腹手术组术后切口感染率为6.71%,两组相比较有显著性差异(P＜0.05).结论:对化脓性阑尾炎采用LA进行早期诊断和早期手术治疗,并做好切口保护,正确处理渗出液和合理使用抗生素,可以降低切口感染率的发生.     

Cataract surgery and postoperative complications in diabetic patients

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.     

Efficacy of a combination of dioxidine with beta-lactam antibiotics in the prevention and treatment of purulent-inflammatory complications

Schemes for prevention and treatment of purulent inflammatory complications were developed on the basis of in vitro studies on antimicrobial activity of dioxidine and 7 beta-lactam antibiotics such as mezlocillin, carbenicillin, ampicillin, cefotaxime, cefoxitin, cefuroxime and cephalothin under conditions of aero- and anaerobiosis with an account of the isolated microflora, its sensitivity to antibacterial agents and conditions required for vital activity of obligate anaerobes in humans, i.e. decreased partial oxygen pressure, low oxidation-reduction potentials and high tissue concentrations of carbon dioxide. The use of dioxidine in combination with the antimicrobial drugs enabled one to decrease the number of cases with purulent inflammatory complications after large intestine esophagoplasty to 30.4 per cent against 67.5 per cent in the control group of the patients untreated preventively with the antibacterial drugs. The number of cases with similar complications after gastrectomy amounted to 16.1 per cent against 62 per cent in the control. The use of dioxidine+ in combination with ampicillin and cefotaxime in treatment of purulent necrotic affections of the foot in patients with diabetes mellitus enabled one to increase the number of satisfactory outcomes by 32 per cent, to decrease the number of high amputations by 21.9 per cent and to lower the number of deaths more than 2-fold as compared to the results in the control group of the patients subjected to chemotherapy based on sensitivity of the aerobic microflora alone.