Microbial structure and sensitivity of pathogenic flora to antibiotics in patients with woundings of abdominal cavity
Background. Since the beginning of the armed conflict in the east of Ukraine, the relevance of the treatment of servicemen with gunshot wounds to the abdomen has increased significantly. Mortality after such injuries is about 31 %. Injuries received during the fighting are contaminated and infected from the moment of injury. During the staying of the patient in the hospital and the intensive care units for more than 10 days, the probability of joining nosocomial strains increases by 50 % and the possible process of dynamic change of pathogens may initiate. The study tested the change in microbiological structure, sensitivity and resistance of microorganisms to antibiotics in abdominal cavity wounds. Materials and methods. There was performed a retrospective analysis of medical record cases of 15 inpatients with abdominal injuries and at least two microbiological cultures. We studied the results of the sensitivity of cultures from abdominal wounds, sputum and urine, which were divided into 2 groups: the first culture and the next of each biological material. Results. All the wounded were male. The mean age was 31.9 ± 10.4 years, the mean duration of inpatient treatment was 48.6 ± 31.4 bed-days. All patients had injuries to the hollow organs of the abdominal cavity. The mortality rate was 33 %. One hundred and six samples of microorganisms were isolated. The results obtained showed a change in the species and quantitative composition of bacteria between the first and second groups of each biological material taken for the microbiological research. There is a quantitative predominance of gram-negative flora over gram-positive in all media of the first and second groups, except for blood, where the gram-positive microorganisms prevailed. The emergence of new pathogens typical for nosocomial flora was revealed in the next cultures. The study of the sensitivity of microorganisms to antibiotics revealed the prevalence of gram-negative strains over gram-positive ones and a tendency to the increased resistance in both groups. Conclusions. The dynamics of the microbiological structure indicates that the cause of the inflammatory process in the abdominal cavity is mainly gram-negative pathogens, less gram-positive, with pronounced antibiotic resistance. Further, nosocomial flora enjoins, which has increased resistance including to reserve antibiotics.