RU2291428C2 - Method for predicting wound suppuration - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: about 1-3 d after trauma it is necessary to carry out inoculations from wound's lumen and in case of gram-positive sporogenous catalase-forming bacilli one should conclude upon low risk of surgical infection development, and in case of detecting the above-mentioned bacteria in purulent wound - its relatively rapid healing.

EFFECT: higher accuracy and efficiency of prediction.

7 ex, 1 tbl

Description

The invention relates to medicine, to methods for early prediction of the occurrence of suppuration in case of accidental wounds, after performing planned surgical interventions, thermal injury.

Currently, despite the use of the most modern methods of prevention, the problem of diagnosis and treatment of surgical infection remains relevant. For the purposes of early diagnosis of purulent-inflammatory complications, Ioffe, Kavetsky, Rotter, with dinitrochlorobenzene, blast transformation tests are used (Yu.G. Shaposhnikov et al., 1974, 1979, 1984; M.I. Kuzin, B.M. Kostyuchenok, 1981) . These methods require the introduction of chemicals to the patient, including allergens. Naturally, this is not always harmless to the patient. There is also a microbiological method for the early diagnosis of suppuration by determining the number of bacteria in one gram of tissue (M.I. Kuzin, B.M. Kostyuchenok, 1981). If the threshold is exceeded, 10 ⁵ colony forming units of bacteria per 1 g of tissue are diagnosed with an early stage of suppuration. However, this method requires the collection of a relatively large number of viable tissue from the wound, effective only with a pronounced development of suppurative process. It does not make it possible to predict suppuration in the first few days after injury and surgery.

The novelty of the study is the study of the microflora of wounds in the early stages of its healing, since during this period the type of vegetative bacteria largely determines the outcome of the wound process.

A significant difference of the proposed method is that 1-3 days after the injury, crops are made from the wound lumen and, in the presence of gram-positive spore-bearing, catalase-producing rods, a low probability of developing a surgical infection is established, and if these bacteria are detected in a purulent wound, its healing relatively quickly .

For these purposes, the skin is treated with antiseptics and with the help of a small sterile swab or microbiological loop from the wound lumen 1-3 days after the injury or operation, sowing on a sterile meat-peptone broth is carried out. Inoculated tubes are incubated in an incubator at a temperature of (36 ± 1) ° C for 24 hours. Subsequently, in the presence of bacterial growth, they are identified by Bergi (Brief identifier of bacteria Bergi, Moscow, Mir, 1980, 496 pp.). Identified bacteria give a characteristic growth in the form of slight turbidity of the broth and the formation of films on the surface. Gram staining is performed; microscopy determines the presence of gram-positive rods forming spores. The bacterial culture is placed in a drop of a 4% hydrogen peroxide solution and the presence of catalase production is diagnosed by the formation of gas bubbles. If gram-positive spore-bearing rods forming catalase are detected, a conclusion is drawn about the favorable course of the wound process. With sterile crops and especially with the detection of other bacteria (staphylococci, Escherichia coli, Proteus, Pseudomonas aeruginosa, etc.), a high probability of the development of suppurative process is established, which makes it possible to carry out early prophylaxis of suppuration long before the appearance of their clinical symptoms.

To date, microorganisms have been investigated immediately after injury, before suturing the wound and with suppuration. In the absence of clinical symptoms, when it is believed that the wound heals by first intention, the microflora of wounds has not yet been investigated. The stereotype works here. If the wound heals by first intention, then a person has strong immunity and the wound is sterile. We first discovered that most patients have microorganisms in wounds 1-3 days after the injury, and the type of vegetating bacteria largely determines the nature of the course of the wound process.

To illustrate the following examples.

Example 1

Patient Z., 49 years old. Entered with a closed fracture of the left thigh. Performed osteosynthesis with a plate. After the operation, antibacterial drugs were not prescribed. A day later, gram-positive spore-producing bacilli producing catalase were isolated from the wound. Sutures were removed on the eighth day. The wound healed by primary intention.

Example 2

Patient K., 36 years old. Entered with a closed fracture of the left thigh. Performed osteosynthesis with a plate. After the operation, antibacterial drugs were not prescribed. A day later, saprophytic staphylococcus was isolated from the wound. On the 7th day, purulent discharge appeared from the wound.

Example 3

Patient V., 28 years old. I was undergoing treatment for a closed fracture of the right lower leg. After the operation, antibiotics are prescribed. The sowing of the discharge from the wound on the third day was sterile. On the 6th day, purulent discharge appeared from the wound.

Example 4

Patient K., 61, at enrolled in burn treatment with lower limb 14% III ^a degree. Upon receipt, a wound toilet was made, dressings with a solution of furatsilin were applied. On the second day, Staphylococcus aureus and gram-positive spore-bearing bacilli were isolated from the wounds. The patient was discharged 2 weeks after wound healing.

Example 5

Patient G., 44 years old, was admitted for treatment of a burn of the upper extremities and chest 12% III ^and degree. Upon receipt, a wound toilet was made, dressings with a solution of furatsilin were applied. On the second day, E. coli was isolated from the wounds. Suppuration developed. The patient was discharged after wound healing after 45 days.

Example 6

Patient A., 56 years old, was treated with exacerbation of chronic post-traumatic osteomyelitis of the right lower leg. The operation was performed fistulosekvestrnekrectomy with drainage of the cavity. Prescribed antibiotics. On the 3rd day after the operation, gram-positive, catalase-producing spore-bearing bacilli were sown from the wound. The patient was discharged from the hospital 17 days after wound healing.

Example 7

Patient S., 48 years old, was treated with exacerbation of chronic osteomyelitis of the left thigh. The operation was performed fistulosekvestrnekrectomy with drainage of the cavity. Prescribed antibiotics. On the 3rd day after the operation, the proteus mirabean was sown from the wound. The patient was discharged from the hospital after 49 days.

This forecasting method has been tested in 457 patients with limb injuries. The results are presented in the table. 362 patients were observed after bone and intraosseous osteosynthesis. On days 1-3 of the postoperative period, gram-positive spore-bearing bacilli secreting catalase were found in 132 people. Superficial suppuration developed in one of them (0.8%). In 140 patients, microorganisms were not found in the wound; suppurations were detected in 12 of them (8.6%). Staphylococci, streptococci, gram-negative bacilli, etc. were isolated from the wound in 90 patients, purulent-inflammatory complications were noted in 12 (13.3%). 51 patients were observed with occasional soft tissue damage. Gram-positive spore-bearing sticks were sown in 7 people, they did not have suppuration. At the same time, out of 26 patients with sterile cultures, suppuration was in 4 (15.4%), and in the presence of other microflora - in 4 of 18 (22.2%). We observed 44 patients with open fractures of the limbs. On days 1-3 of the postoperative period, gram-positive spore-producing bacilli producing catalase were isolated in 15 people, suppuration was recorded in one patient (6.7%). In the absence of bacteria, purulent-inflammatory complications were noted in 9 (50.0%) out of 18 patients, and when staphylococci, streptococci, gram-negative enterobacteria, etc. from 11 people were isolated, suppurations were observed in 5 (45.5%). Thus, the likelihood of suppuration during isolation from the wound of gram-positive spore-bearing, catalase-producing rods 1-3 days after the operation is 11.7 times less than with sterile cultures or the presence of other microflora (p <0.01).

In 9 patients with burns ^and III degree was 16.1 ± 0.8 days, and the presence of other microflora in 23 patients upon detection of gram-positive spore-forming rods average period of wound healing - 25.8 ± 2.7 days (p <0.01 ) In 5 out of 8 patients with chronic osteomyelitis, the wounds healed within 15 to 30 days after the addition of gram-positive spore-bearing rods. At the same time, in their absence, recovery occurred much later (p <0.01).

Table
The frequency of suppuration, depending on the composition of the microflora of the wound for 1-3 days after injury and surgery. Type of injury Gram-positive spore bacilli No microorganism growth Other microflora Total Number of patients Of these suppurations Number of patients Of these suppurations Number of patients Of these suppurations Number of patients Of these suppurations Closed fractures (metallosteosynthesis) 132 1 (0.8%) 140 12 (8.6%) 90 12 (13.3%) 362 25 (6.9%) Random soft tissue wounds 7 0 26 4 (15.4%) eighteen 4 (22.2%) 51 8 (15.7%) Open fractures fifteen 1 (6.7%) eighteen 9 (50.0%) eleven 5 (45.5%) 44 17 (38.6%)

Information sources

1. Kuzin M.I., Kostyuchenok B.M. Wounds and wound infection. M., Medicine, 1981, 688 p.

2. Shaposhnikov Yu.G., Reshetnikov EA, Ionesyan-Zverkova BI, Kondratyev I.E. The development and course of wound infection and the general immunological reactivity of the body. // Military Medical. Journal, 1974, No. 7, pp. 23-24.

3. Shaposhnikov Yu.G., Reshetnikov EA, Kondratyev I.E. Prevention and treatment of suppuration of wounds. // Surgery, 1979, No. 8, pp. 14-19.

4. Shaposhnikov Yu.G., Reshetnikov EA, Rudakov B. Ya. Et al. Diagnosis and treatment of wounds. M., Medicine, 1984, 344 p.

Claims (1)

A method for predicting suppuration of wounds by examining microflora, characterized in that 1-3 days after the injury, crops are sown from the wound lumen and, in the presence of gram-positive spore-bearing catalase-forming rods, a low probability of developing a surgical infection is established, and if these bacteria are detected in a purulent wound, a favorable course wound healing.