THE PECULIARITIES OF THE PATIENTS’ MICROFLORA WITH CHRONIC WOUNDS

Kasrashvili G. G., Ksonz I. V., Gulmamedov P. F., Andreev O. V., Kolesnik H. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The role and the importance of microorganisms in wound healing have been discussed for many years. However, some experts believe that the level of bacterial contamination is crucial for predicting wound healing and infection, while others give priority to the types of microorganisms. Thus, these and other factors such as microbial synergism, the patient’s immune response, soft tissue status should be considered together when assessing infection probability. As a result of bacterial reproduction the normal phase of the wound process is delayed that can lead to degenerative changes in the wound. The updated guidance of the International Wound Infection Institute has suggested that the term “microbial” rather than “bacterial” should be used when discussing wound infection. The goal of the work is to identify and analyze the features of the microflora of chronic wounds depending on the etiological factor. Object and methods of the research. There have been used generalized results of microbiological study of 75 patients, aged 21 to 92 years, with chronic wounds of different etiology (group 1 - disorders of venous outflow, group 2 - disorders of arterial patency (macroangiopathy), group 3 - disorders of microcirculation (microangiopathy), 4 - long-term healing, post-traumatic and postoperative wounds.). Among the patients there were 36 (48.0%) males and 39 (52.0%) females whose mean age was 60.5 ± 1.7 years. The selected groups were statistically compared by the patients’ age and sex (p> 0.05).The method of bacteriological inoculation of wound discharge into aerobic and optional anaerobic microflora was used. Statistical processing of the study results was performed using Statistica v.6.1 software package (Statsoft Inc., USA). Results and discussion. It has been found out that the structure of wound infection is dominated by grampositive microorganisms of staphylococcus genus ‑ 64.0% (48 patients). Non-fermentative gram-negative bacteria were detected in every fifth case ‑ 20.0% (15 people), gram-negative bacteria of Escherichia coli group ‑ in 9.3% of the cases (7 patients). There was not detected any flora growth in 5 (6.7%) cases. Significant differences were determined between the microflora of wounds with different etiology. According to the results of the study of the sensitivity of the microflora of wound secretion to antibacterial drugs it was established that staphylococci were most susceptible to the pharmacological groups of aminoglycosides (33.3%), glycopeptides (31.3); gramnegative bacteria of the group of Escherichia coli ‑ to cephalosporins (42.9%) and antimicrobial agents (57.1%); nonfermentative gram-negative bacteria - to aminoglycosides (66.7%), cephalosporins (40.0%). The use of adequate antibiotic therapy in complex treatment of chronic wounds led to positive results (wound closure) in 36 (48.0%) patients. In other cases (52.0%) a significant reduction in the area of the wound surface and the formation of marginal epithelialization of the wound were achieved. Conclusions. 1. Significant differences between the microflora of chronic wounds with different etiology have been found out (p <0.05). 2. Gram-positive microorganisms have been most susceptible to amikacin and vancomycin. Gram-negative bacteria of Escherichia coli group are the most sensitive to phosphomycin and cefoperazone. And gram-negative bacteria are sensitive to amikacin (tobromycin) and also cefoperazone. 3. The best treatment results were obtained in wounds without bacterial contamination as well as in staphylococcal contamination of wounds (p <0.05 compared with that in Escherichia coli group (criterion χ2). 4. There wasn’t determined any significant dependence of treatment results on the etiological factor of wound formation (χ2 = 1,68, p> 0,05), indicating that all the wounds healed approximately equally in complex treatment with adequate antibacterial therapy.

chronic wounds, different etiology, microflora, antibiotic therapy

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«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 140-145 pages, index UDK 616-001.4-036.12:579.61

10.29254/2077-4214-2020-1-155-140-145