Results of 10 years of use of lincomycin (1966-1976) in the clinics of the N. N. Priorov Central Research Institute of Traumatology and Orthopedics]

During 10 years 1063 patients were treated with lincomycin used parentally or orally at the N. N. Priorov Central Research Institute of Traumatology and Orthopedy. The doses and the rate of its use depended on the state of the patient, its age and weight. Lincomycin was used for the treatment of patients with osteomyelitis or purulent wound infection, as well as for prophylaxis of suppuration. The drug was used for a long period of time under conditions of the same hospital, and it was shown that it remained up to the present days highly effective in therapy of infections and especially bone infections caused by staphylococci sensitive to it. The 10-year study of staphylococcal sensitivity to lincomycin revealed an insignificant increase in the development of resistance to it. The paper presents data on the importance of adequate surgical interventions in addition to the antibiotic therapy in cases with bone infections. A possibility of lincomycin combined use with other antibiotics and gentamicin or kanamycin in particular was shown. Complications, such as diarrhea and urticaria were registered in 11 patients.     

Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources.

OBJECTIVES--To estimate the cost effectiveness of giving prophylactic antibiotics routinely to reduce the incidence of wound infection after caesarean section. DESIGN--Estimation of cost effectiveness was based, firstly, on a retrospective overview of 58 controlled trials and, secondly, on evidence about costs derived from data and observations of practice. SETTING--Trials included in the overview were from obstetric units in several different countries, including the United Kingdom. The costing study was based on data referring to the John Radcliffe Maternity Hospital, Oxford. SUBJECTS--A total of 7777 women were included in the 58 controlled trials comparing the effects of giving routine prophylactic antibiotics at caesarean section with either treatment with a placebo or no treatment. Cost estimates were based on data on 486 women who had caesarean sections between January and September 1987. MAIN OUTCOME MEASURE--Cost effectiveness of prophylaxis with antibiotics. RESULTS--The odds of wound infection are likely to be reduced by between about 50 and 70% by giving antibiotics routinely at caesarean section. Forty one (8.4%) women who had caesarean section were coded by the Oxford obstetric data system as having developed wound infection. The additional average cost of hospital postnatal care for women with wound infection (compared with women who had had caesarean section and no wound infection) was estimated to be 716 pounds; introducing routine prophylaxis with antibiotics would reduce average costs of postnatal care by between 1300 pounds and 3900/100 pounds caesarean sections (at 1988 prices), depending on the cost of the antibiotic used and its effectiveness. CONCLUSIONS--The results suggest that giving antibiotics routinely at caesarean section will not only reduce rates of infection after caesarean section but also reduce costs.     

1235例创伤并发创面感染的病原学调查

目的 调查创伤并发创面感染的细菌分布和耐药现状,为合理使用抗菌药物提供依据.方法 嘉兴市第二医院2005年至2010年1235例创伤并发创面感染的分泌物采用哥伦比亚血琼脂做细菌培养,法国生物梅里埃公司VITEK-32型全自动生物分析仪进行鉴定和药敏.结果 1235例创面感染共培养出细菌1208株.G-杆菌、G+球菌、真菌分别占51.82％、39.57％、8.11％.G-杆菌对头孢类抗菌药物高度耐药,对美洛培南和亚胺培南敏感;G+球菌对β-内酰胺类抗菌药物普遍耐药,对万古霉素、利奈唑烷和莫昔沙星敏感.结论 创伤并发创面感染常见病原菌为铜绿假单胞菌、表皮葡萄球菌、金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌,且对抗菌药物多重耐药.     

Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane

Background

Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue.

Methods

Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients.

Results

In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia.

Conclusion

Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.     

Primary closure of human bite losses of the lip.

Human bite injuries of the lip have, because of the potentially contaminated nature of the wounds, been managed by delayed repair after an interval of about 3 months or more when the infection was controlled and the wound healed. On the contrary, from 1985 to 1990, at a plastic surgery unit in Nigeria, a developing country, 37 patients with human bite losses of the lip were managed by an aggressive approach utilizing (1) a 5-day course of antibiotics locally known to be effective against bacterial flora and (2) immediate surgical operation employing the diamond wedge excision method under local anesthesia with direct wound closure. The results have been so favorable that this method of management of human bite injuries is considered a treatment advance.     

嗜麦芽窄食单胞菌感染的临床特征、高危因素及预后分析

目的了解嗜麦芽窄食单胞菌感染的临床特点、危险因素、预后及耐药现状,为有效预防和治疗该病原菌感染提供依据。方法收集2013年11月至2014年4月浙江大学医学院附属第一医院收治的129例细菌培养为嗜麦芽窄食单胞菌患者的临床资料进行回顾性统计分析。结果 129例细菌培养确诊嗜麦芽窄食单胞菌感染患者平均年龄（65.1±17.0）岁,包括下呼吸道感染和非呼吸道感染患者分别为100例和29例,下呼吸道感染患者存在原发肺部疾病的患病率、ICU入住率、气管切开比例、广谱抗生素的使用率、患病年龄等均高于非呼吸道感染患者（P〈0.05）。而非呼吸道感染患者的外科手术、无菌腔内置管比例及免疫抑制剂使用率高于下呼吸道感染患者（P〈0.05）。嗜麦芽窄食单胞菌感染后选择敏感抗生素治疗的患者的死亡率明显低于未选择敏感抗生素的患者（15.0%/30.4%,P〈0.05）。结论原发肺部疾病、入住ICU、气管切开、广谱抗生素使用、年龄大是下呼吸道感染嗜麦芽窄食单胞菌的高危因素,外科手术、无菌腔内置管、免疫抑制剂使用是非呼吸道感染嗜麦芽窄食单胞菌的高危因素。使用敏感抗生素可以降低嗜麦芽窄食单胞菌感染患者的死亡率。     

A novel titanium wound chamber for the study of wound infections in pigs

In the face of emerging multidrug-resistant microbes, reliable animal models are needed to study potential new therapies in infected wounds. To this end, we implanted screw-top titanium chambers subdermally in full-thickness wounds on both flanks (n = 6 per flank) of 2 Goettinger minipigs. After 1 wk, chambers were inoculated with Staphylococcus aureus, Pseudomonas aeruginosa, or vehicle only. Throughout the study, wound fluid was harvested for quantitative bacterial cultures to monitor infection. Animals were followed for 4 wk, after which tissue biopsies were taken for histologic analysis and quantitative bacterial counts. The implanted titanium chambers were well tolerated by the pigs throughout the study. After inoculation of the chambers, wound infection was established and maintained for 14 d. Despite infection, no systemic effects were noted. Cross-contamination was negligible, compared with the vehicle-only control. After tissue ingrowth, each chamber creates a closed system that allows harvest of exudate or application of substances without loss of material from the chamber. Because 12 chambers are implanted in each pig, researchers have the opportunity to compare multiple treatment options (for example, antibiotics, antimicrobial peptides, gene therapy) in the same animal, with no interindividual variation. We conclude that the use of titanium chambers in pigs provides a reliable and reproducible in vivo model to investigate wound healing, wound infection, and treatment options.     

急性血源性骨髓炎全身与局部抗生素治疗体会及重症病例分析

目的:总结急性血源性骨髓炎尤其是重症患者治疗中全身及局部抗生素应用的经验、方法及临床疗效。方法:回顾性分析空军军医大学第二附属医院2016年11月至2019年4月收治的12例急性血源性骨髓炎患者,其中3例为合并肺脓肿的重症败血症患者。对患者首先进行经验性全身抗生素治疗,并进行细菌学分析,然后根据药敏结果进行系统抗生素调整,采用万古霉素负载的硫酸钙/磷酸钙复合物进行局部抗生素缓释治疗,分析治疗前后实验室指标变化、局部影像学变化。结果:细菌学培养显示金黄色葡萄球菌10例,人葡萄球菌1例,阴沟肠杆菌1例;平均随访56.6周;治疗后患者白细胞(WBC)、中性粒细胞百分比(NEUT%)、红细胞沉降率(ESR)、高敏C反应蛋白(hs-CRP)等指标均恢复到正常范围内;影像学显示患者病灶处骨重建及新骨形成良好,无感染复发迹象;12例患者中成功治愈11例,治愈率91.7%;1例转为慢性骨髓炎,二期手术后痊愈;其中3例骨髓炎合并重症败血症、肺脓肿患者经系统抗生素及外科治疗,全部治愈。结论:急性血源性骨髓炎的致病菌主要为甲氧西林敏感金黄色葡萄球菌(MSSA),其治疗要在早诊断的前提下,率先经验性应用抗生素,然后根据药敏结果合理选择足量敏感抗生素。苯唑西林在3例合并败血症、肺脓肿的重症患者治疗中起到了关键作用,同时局部采用硫磷复合物负载万古霉素进行治疗,既可以实现局部抗感染作用,又可以促进新骨形成,有效控制全身感染、消除败血症,临床疗效满意。     

Experimental and clinical study of immunomodulators Immunomax and Gepon in complex treatment of acute purulent surgical infection]

The efficacy of the immunomodulators immunomax and gepon in the treatment of acute purulent surgical infection of soft tissues was studied under experimental and clinical conditions. Gepon was used in the form of 0.04% ointment in the phase of the wound infection regeneration vs. the routine use of 10% methyluracil ointment. Immunomax was administered in a dose of 40 units under the experimental conditions and 200 units in the clinical trial 3 times every 2nd day intramuscularly. The experimental investigation was performed on 20 male guinea pigs in a model of a suppurating wound. The animals were divided into 2 groups (main and control) of 10 animals each. Flat wounds were prepared according to the A. V. Nikolaev's method. The clinical trial enrolled 126 patients with acute surgical infection of the soft tissues. The patients were treated in the Hospital of General Surgery of the Faculty of Pediatrics of the Russian State Medical University during the period from 2003 to 2004. The patients were divided into 2 groups (main and control). The structure of the main and control groups was comparable by the sex and age of the patients, nosological forms and severity of the disease. The patients of the main group (65 subjects) were given the immunomodulators in complex with the routine surgical treatment and drug therapy. The patients of the control group (61 subjects) were given the same surgical treatment and drug therapy but without the use of the immunomodulators. General and local manifestations of the purulent infection were considered as the criteria of the treatment efficacy. The qualitative and quantitative composition of the wound bacterial infection was determined and histological examination of the wound bioptates was performed. Planimetry of the wound surface was carried out and the acceleration index of the wound clearing and healing was evaluated. In the total, high therapeutic efficacy of immunomax and gepon, practically no contraindications and adverse reactions to their use, the ease and simplicity of their handling can be stated.     

A meta-analysis of prophylactic antibiotics in head and neck surgery.

Although it is generally agreed that prophylactic antibiotics are necessary for the prevention of postoperative wound infection, the choice of antibiotic regimen is controversial. In an attempt to determine the most effective antibiotic regimen, a meta-analysis of published clinical trials of prophylactic antibiotics for head and neck surgery was undertaken. The meta-analysis revealed a relative difference in infection rates of 43.7 percent in favor of the use of antibiotics versus placebo, of 8.3 percent in favor of multiple antibiotics versus a single antibiotic, of 13.7 percent in favor of multiple antibiotics versus cefazolin, and of 4.1 percent in favor of multiple-day prophylaxis versus single-day prophylaxis. This meta-analysis suggests that a 1-day course of clindamycin may be the most effective prophylactic antibiotic regimen for head and neck surgery.     

Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital,Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design

Introduction

In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals.

Methods

We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design.

Results

From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these.

Conclusion

Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.     

Treatment of orthopedic infections caused by resistant staphylococci

During 1999-2005 we treated 15 patients with linezolid for relevant infections of locomotion apparatus (7 cases with endoprosthesis infection, 5x osteomyelitis and 3x another infection). With the exception of one case the antibiotic therapy was always combined with appropriate surgical intervention. Average period of linezolid administration was 26 d; linezolid was applied from the beginning intravenously on average for 10 d, and then orally for 16 d (average). There were no undesirable effects in the file. Success rate reached 86.6%. MRSA strains were proved by standard methods: growth on Mueller-Hinton agar with increased concentration of NaCl and 2 mg/L of oxacilline, and measuring inhibitory zones around cephoxitine disk. The sensitivity to other antibiotics was specified by disk-diffusion test; that to linezolid was verified by E-test. Linezolid represents a medical reserve for the treatment of multiresistant Gram-positive infections or for emergencies, when allergy onset, high toxicity risk, intolerance, etc. do not allow to use other, in vitro effective, antibiotics.     

Application of wound dressing Molndal technique in clean and potentially contamined postoperative wounds--initial comparative study

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (4%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration. In the traditional technique group 4 (16%) patients developed wound infection as inflammation and secretion as a sign of superficial infection. In the other group we analyzed the results of 50 patients after implantation of partial endoprosthesis after hip fracture. 20 patients were treated by Molndal technique and 30 patients by the traditional technique of wound dressing. In the group treated by Molndal technique no patient has revealed a wound infection (0%). In the traditional technique group 4 (13%) patients developed wound infection. All complication in both group were superficial incisional surgical infection (according to HPSC). There was no deep incisional surgical site infection or organ/space surgical site infection. Our results are clearly showing that Molndal technique is effective in preventing the postoperative wound infection.     

Rational use of antibiotic therapy after appendicectomy.

A prospective randomised trial was carried out on 263 patients admitted for appendicectomy. In those patients with normal or inflamed appendix only, wound sepsis occurred in five (5%) of the 96 patients receiving metronidazole compared with seven (7%) of the 91 controls. In patients with gangrenous or perforated appendices, however, 15 of the 32 patients (47%) receiving ampicillin and five (16%) of 31 patients receiving metronidazole developed a wound infection (p less than 0.025). Therapeutic courses of metronidazole significantly reduced wound sepsis rate in those with gangrenous or perforated appendices. Together with another antibiotic it should form part of the management of such patients, but antibiotics are unlikely to reduce further the low rate of wound infection in patients with normal or inflamed appendices.     

道路交通事故致胫腓骨骨折的特点及救治

目的：总结交通事故伤中胫腓骨骨折的流行病学分类、特点及救治注意事项。方法：对136例交通事故伤中胫腓骨骨折患者的临床资料进行回顾性分析。结果：交通事故致胫腓骨骨折以多发伤及复合伤多见,经早期彻底清创、恰当的骨折固定、抗生素应用等,治愈77例,截肢2例,伤口浅表感染6例,骨髓炎1例。结论：交通事故伤中胫腓骨骨折大多伤情严重,感染率高,且开放性居多,早期及时选择合适的治疗方法是取得良好预后的关键。     

THE TREATMENT OF SINUSITIS IN CHILDREN

The sulfonamides and antibiotics have been of great value in reducing the duration and severity of acute sinusitis in children.Chemotherapy, in the acute case, will probably prevent much chronic sinusitis of the infectious type.The most common variety of chronic sinus disease is due to a primary allergic condition plus secondary infection. It is impossible to treat these cases successfully without treating the allergy as well as the infection.The home use of any nose drop preparation is of very little value in the treatment of chronic sinusitis of any type or localization.The local nasal use of sulfonamides or antibiotics is not based upon rational principles. Their clinical value is negligible. They may, moreover, be decidedly irritating to the nasal mucosa.One should not hesitate to resort to rational surgical procedures to improve nasal ventilation in a child with sinusitis.While the advent of chemotherapeutic, antibiotic and antihistaminic drugs has been of inestimable value in the treatment of chronic sinusitis, we must not neglect to surgically correct anatomical defects and irreversible pathological mucosal changes which interfere with proper nasal physiological processes.     

Mathematical approach to modeling of the treatment of suppurative processes

Consideration of an inflammation focus as an "open system" provided analogy between microbiological processes in inflamed wounds and in systems of continuous cultivation of microorganisms. Mathematical modeling of such systems is widely used. Some of the methods for the mathematical modeling were applied to chemoprophylaxis and chemotherapy of postoperative wounds. In modeling continuous cultivation of microorganisms it is usually necessary to determine optimal conditions for the maximum yield of their biomass. In modeling of wound treatment the aim was to determine the process parameters providing the minimum biomass. The described simple models showed that there could be certain optimal flow rate of the washing fluid in the aspiration-washing procedure for wound treatment at which the drug was not completely washed out while the growth rate of the microbial population was minimal. Such mathematical models were shown valuable in optimizing the use of bactericidal and bacteriostatic antibiotics.     

The changing picture in surgery of pulmonary tuberculosis

In a review of the operative treatment of 1,271 patients with pulmonary tuberculosis in an 11-year period, it was noted that, beginning with 1947, there was a great increase, relatively, in the number of cases in which pulmonary resection was carried out. In 1943, the first year of the period of study, there were six minor operative procedures to every four major operations; in 1953 the ratio was one minor to nine major. This reversal reflects the discoveries of antibiotics for conservative therapy on the one hand and the advances in surgical techniques for major operative treatment on the other. Now that it is safer, resection will probably be used more and more-including bilateral resection in "salvage" cases. On the other hand, with specific antibiotics available, there is a tendency at present to treat conservatively for longer periods in cases in which, formerly, minor operative procedures would have been carried out early.