CLINICAL EVALUATION OF THE FEATURES OF CURRENT PANCREATIC INFECTION AS A COMPONENT OF THE MULTIDISCIPLINARY PRINCIPLE OF TREATMENT TACTICS IN ACUTE PANCREATITIS

Abstract

Objective. To study the main features of current pancreatic infection with an assessment of the clinical significance of the data obtained in the implementation of the multidisciplinary and comprehensive approaches to optimal managementof patients with acute pancreatitis. Methods. 147 bacteriological studies of liquid (peripancreatic fluidcollection) and tissue (fragments ofnecrotized gland and retroperitoneal tissue) were carried out using the methods of aerobic (80) and anaerobic (67) cultivation and determination of the sensitivity of microflora to antibiotics. Regimes of antibiotic therapy (preventive / etiotropic) were determined during the treatment of patients (n=460). Results. The dominance of aerobic bacteria in the form of monoculture (37%) and aerobic-anaerobic associations (39%) with gram-negative signs (56%) and the constancy of microbial associations in 54% of cases was established. It was found that the addition of an infectious factor to the primary aseptic inflammatory process occurs both in the early - up to one week (17%), and late - after three weeks (31%). The signs of pancreatic infection, which can serve as objective criteria for assessing the severity of the course of acute pancreatitis, were identified - infection of the gland tissue / retroperitoneal tissue, early attachment of a bacterial factor, dominance of aerobic-anaerobic associations and gram-negative microflora inclusion. The sensitivity of bacteria to antibiotics and the conditions for the multidrug resistance development were determined. The principles ofuseofantibacterial agents at various stages of treatment in the modes of preventive and etiotropic therapy have been substantiated. Conclusion. Current pancreatic infection in acute pancreatitis is microflora in the form of monoculture (37%) and aerobic-anaerobic associations (39%) with gram-negative inclusion (56%) and a prevalence of enterobacteria and anaerobic non-clostridial flora. Infection of the gland / retroperitoneal tissues, early bacterial factor, the dominance of gram-negative aerobic-anaerobic associations, objectifies the severity of the disease. Preventive antibiotic therapy for pancreatic necrosis promotes to the preservation of the asepticity of the inflammatory process in 68% of cases. The use of etiotropic antibiotic therapy is indicated in the postoperative period due to the development of microflora resistance. What this paper adds The features of current pancreatic infection such as the aerobic and anaerobic spectrum microflora, tinctorial and associative signs, tropism to tissue and fluid substrates, sensitivity to antibiotics, the timing of pancreatic infection have been studied. The expediency of evaluating the results of bacteriological studies from the standpoint of a multidisciplinary approach in problem-solving therapy, an objective assessment of the disease severity and justification of the choice of antibiotic therapy regimen have been shown.