Immunocorrective antibacterial therapy in treatment of widespread purulent peritonitis.

Magomedov M. M. , Rabadanov Sh.H. Gamzatov G. M., Magomedova Z. A., Nurmagomedova P. M.

Dagestan State Medical Academy, Russia

Relevance. Widespread purulent peritonitis , like many years before, took the lead problematic position of contaminated surgery . Revealed significant changes in the sensitivity of the main causative agents of widespread purulent peritonitis to antibiotics . In recent years the purulent infection is characterized by multiple , rapidly growing resistance to antibiotics and antiseptics , which raises the need for further study of the etiological structure of widespread purulent peritonitis with a view to developing effective schemes of rational antibiotic therapy.

The progression of peritonitis accompanied by immunosuppression . The totality of these changes leads to an increase in the deficit of energy-rich compounds, and as a result, gipoergozu immunocompetent cells. In this regard, relevant is the potential use of immune corrective therapy in the treatment of patients with advanced purulent peritonitis .

The purpose of the study. Explore ways to improve the antibacterial and immune corrective therapy in the complex treatment of patients with diffuse purulent peritonitis .

Materials and methods. Investigations of peritoneal exudates , 38 patients with diffuse purulent peritonitis . The character of the gram-negative aerobic and anaerobic non-clostridial microflora , defined by its sensitivity to antibiotics , as well as establish effective scheme of rational antibiotic therapy.

A comprehensive examination and treatment of 35 patients with diffuse purulent peritonitis . Patients were divided into 2 groups: basic and control . Formation control and basic groups was performed by blind randominazatsii .

Unlike the main group ( 20 patients) from the control group ( 15 patients) was the fact that, given the traditional treatment for 5 days and postoperative drug pentoglobin additionally used at a dosage of 0.4 ml / kg per day intravenously , depending on the degree of the severity of patients . And control groups were comparable in terms of age structure , sex, nosology forms of the disease. Were accepted as the norm indicators of healthy volunteers , donors ( n = 10).

For immunological studies carried out on the fence venous 1 , 3rd - 5th , 7 th and 10 th postoperative day . Was isolated from the obtained blood mononuclear cells, monocytes and lymphocytes. Mitogen- induced activity of immunokopetentnyh cells was studied in the reaction of migration inhibition of neutrophils (PTMJI) in direct capillary test .

Statistical data processing was carried out in accordance with the requirement imposed on the research in the field of medicine using electronic packet analysis «STATISTICA 6.0» and «Excel».

Results: In the microbiological investigation of peritoneal fluid of patients with advanced purulent peritonitis found that 76.16 % of peritoneal inflammation was caused aerobnoanaerobnoy mixed microflora , 18 % - anaerobes only in 9.11% - just aerobes . The dominant role in the development of peritonitis owns 65.2% of E. coli and Bacteroides (59.8 %).

The effect of pentoglobina on the dynamics of the functional state of mitogen -induced immune cell levels in patients with drasprostranennym purulent peritonitis . Found that immunocompetent cells have investigated regulating effect on the migration of polymorphonuclear leukocytes during widespread purulent peritonitis during the postoperative period. PHA -activated ( fetogemagglyutinin ) mononuclear cells do not cause ingibatsiyu migration of neutrophils observed in the rate. At the same time, activated LPS ( lipopolysaccharide E.coli) monocytes lead to increased migration of neutrophils as compared with data obtained from normal. Using petoglobina in patients with advanced purulent peritonitis has a corrective effect on immune cells , altering the properties of the regulation of migration activity of neutrophils . Identified effects when used pentoglobina most pronounced for the 5- 7th postoperative day .

Conclusion. On the basis of data on the etiological structure and the sensitivity of microorganisms to antibiotics we have proposed the following effective scheme of rational empirical antibiotic therapy widespread purulent peritonitis:

drugs of choice in 1st line (sensitivity 41,8-58,9%)

III generation cephalosporins plus metronidazole;

III generation cephalosporins, aminoglycosides + + metronidazole;

drugs of choice 2nd row (sensitivity 79,1-84,7%)

fluoroquinolone plus metronidazole;

IV-generation cephalosporin + metronidazole;

reserve drug (sensitivity 88,6-100%)

carbapenems.

Application pentoglobina postoperative patients with advanced purulent peritonitis allowed to a certain extent correct the migratory properties of polymorphonuclear leukocytes by the action of PHA-activated mononuklernyh blood cells and provided recovery of regulatory properties KGC-induced monocytes, most pronounced for the 5-7th day. This effect may be associated with the ability to restore the status of the preparation of immune cells.