Year 2017 Vol. 25 No 6

GENERAL & SPECIAL SURGERY

A.M. KUPCHENKO, V.A. KOSINETS

ETIOLOGICAL STRUCTURE OF DIFFUSE PERITONITIS AT VARIOUS LEVELS OF THE GASTROINTESTINAL TRACT DAMAGE

Vitebsk State Medical University, Vitebsk
The Republic of Belarus

Objective. To determine the main causative agents of diffuse peritonitis at various levels of the gastrointestinal tract damage.
Methods. The aerobic and anaerobic microorganisms were identified in the peritoneal exudate of 144 patients with diffuse peritonitis using test systems ENTER-ID and AN-ID; their sensitivity to antibacterial drugs was determined with the test systems AB-ENTER, AB-GRAM(-), AB-PSEV, AB-AN, designed in EE Vitebsk State Medical University. Depending on the level of the gastrointestinal tract damage, the following variants of the pathological process were identified: peritonitis as a complication of the stomach and duodenum diseases (1st level 59 patients); as a complication of the small intestine diseases (2nd level 23 patients); as a complication of the large intestine diseases (3rd level 62 patients).
Results. In case of perforation localization on the 3rd level bacterial microflora was determined in all inoculations, on the 1st level the inoculations proved to be sterile in 27,1% of the cases, on the 2nd level in 8,7%. On the 1st level E. oli (34,04%) and gram-positive aerobic microflora were identified in the peritoneal exudate, B. fragilis only in 20,3%. On the 2nd level in the inoculations gram-negative aerobic microflora prevailed, mainly represented by E.oli (65,21%), anaerobic microflora reached 69,6%. In the inoculations on the 3rd level gram-negative aerobic microflora was more often determined: E.oli (55,36%) and Klebsiella spp. (16,07%), with the dominance of anaerobic component which reached 88,7%. Imipenem (91,3% sensitive microorganisms), amikacin (88,1%), ciprofloxacin (88,1%), meropenem (84,2%) had maximum antibacterial effect on aerobic component. Anaerobic non-clostridial microflora of the peritoneal exudate was most sensitive to meropenem (98,1%), imipenem (96,1%) and metronidazole (91,3%).
Conclusions. Administration of antimicrobial therapy in the treatment of patients with diffuse peritonitis should be carried out taking into account the level of the gastrointestinal tract damage. The obtained data will contribute to the creation of the modern efficient schemes of empiric antimicrobial therapy in the treatment of this disease.

Keywords: diffuse peritonitis, identification of microorganisms, test systems, gastrointestinal microbiome, sensitivity determination, anti-bacterial agents
p. 589-599 of the original issue
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze ave., 27,
EE Vitebsk State Medical University,
Department of Operative Surgery
and Topographic Anatomy,
Tel. +375 33 675-48-62,
E-mail: anna.annushka75@mail.ru,
Anna M. Kupchenko
Information about the authors:
Kupchenko A.M., Senior Lecturer of the Department of Operative Surgery and Topographic Anatomy of EE Vitebsk State Medical University.
Kosinets V.A., MD, Professor, Professor of the Department of Hospital Surgery with Urology and Pediatric Surgery Courses of EE Vitebsk State Medical University.
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