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XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.
Year 2015 Vol. 23 No 1
GENERAL AND SPECIAL SURGERY
S.D. SHAPOVAL, I.L. SAVON, A.N. YAKUNICH, O.O. MAKSIMOVA
RESISTANT AND MULTIRESISTANT AGENTS OF PYONECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME
SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine",
Objectives. To study the microbiological profile and antimicrobial resistance in patients with complicated diabetic foot syndrome (DFS).
Methods. The study involved 174 patients with DFS within 2013-2014 yrs. All patients with diabetes mellitus (DM) II type (average duration 12,8±2,9 years). The average age of the patients was 59,3±5,3 years. The pyo-necrotic injuries of foot – abscess, phlegmon, pyogenic abscess, pyogenic tendovaginitis, pyogenic arthritis, gangrene have been diagnosed in the patients. According to the PEDIS classification the process had P1-2E1-2D2-3I2-3S1-2 characteristics. Determination of the qualitative composition of flora and sensitivity to antibiotics of isolated cultures was performed with the automatic bacteriological analyzer (Vitek 2 Compact – France).
Results. The cause of pyo-necrotic complications of DFS were gram-positive flora in 56,9% of cases, in 33,3% – gram-negative, in 2,9% – anaerobes, in 2,3% – fungi. The phenomenon of resistance to the major antimicrobial drugs was revealed in 65 (37,4%) bacteria. Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Esherihia coli, Acinetobacter baumannii, Enterococcus faecalis had the greatest resistance. Among the groups with the identified Pseudomonas aeruginosa, 66,0% of the bacteria were characterized by a phenotype of resistance to carbapenems, 33,0% of which were panresistant ones. In patients with Staphylococcus aureus in 60,5% of cases the gene of MRSA with three genetic variations differed by resistance to certain groups of antibiotics was revealed. The most important was panresistant one (4,3%).
Conclusion. The antibiotic therapy ineffectiveness in patients with DFS is caused by a large number of resistant and panresistant forms. Active drugs against MRSA are daptomycin, vancomycin, teicoplanin, tigecycline. In case of infections caused by ESBL-producing bacteria the use of carbapenems (imipenem / cilastatin and meropenem) remains topical. Reserve tigecycline for use in situations when alternative treatments not suitable.
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69096, Ukraina, g. Zaporozhe,
bul. Vintera, d. 20,
GZ "Zaporozhskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya MZ Ukrainyi" ,
gnoyno-septicheskoy khirurgii i ultrazvukovoy diagnostiki,
tel.office: 38 (061) 213-15-42,
Shapoval Sergey Dmitrievich
Shapoval S.D. MD, professor, first Vice-rector, a head of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Savon I.L. MD, an associate professor of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Yakunich A.N. PhD, an assistant of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Maksimova O.O. PhD, assistant of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".