Empirical Antibacterial Therapy of Complicated Intra-Abdominal Infections

The purpose of the article is to determine the course of intraabdominal infections during the empirical antibacterial therapy. Object and methods. The materials of 27 patients (19 men and 8 women) with intra-abdominal infections aged 19 to 84 years have been analyzed. Studied clinical and anamnesis data, duration of stay in the surgical hospital, revealed the spectrum of the bacterial flora of the abdominal cavity, features of the appointment of antibacterial therapy, complications of intra-abdominal infections and repeated relaparotomy. Non-parametric methods of statistical processing of material were carried out by means of the program "Statistica 7.0. for Windows ". Results. The spectrum of diagnoses due to intra-abdominal was following: adhesive disease - 2 (7.4%), duodenal ulcer with ulcer perforation - 10 (37%), acute gangrenous and perforative appendicitis - 10 (37%), colon cancer - 5 (18.5%). The course of intra-abdominal infections in all patients was characterized by the development of peritonitis: serous - 3 (11.1%), serous-fibrinous - 4 (14.8%), purulent - 10 (37.0%), fibrinous-purulent - 10 (37, 0%). The postoperative period was characterized in 6 (22.2%) of 27 patients of ranaparatomy due to the severe course and development of postoperative intra-abdominal abscesses: 4 patients with perforated ulcers of 12 colon and 2 patients with colon cancer. The average age of patients with relaparotomy was 63 years, which is more than in the general cohort of patients with peritonitis. The 10 (37.0%) patients have had of concomitant diseases: coronary heart disease (5); infectious hepatitis (1); diabetes mellitus type 2 (1); obesity 3-4 degrees (2); cachexia due to alcoholism (1), community pneumonia (1). All patients with comorbid state developed intra-abdominal abscesses. It should be noted that the clinical manifestation of intra-abdominal infections began in 22 (81, 5%) patients less than 24 hours before admission to a surgical hospital. The high cost of treating intra-abdominal infections and their complications is determined not only by the cost of the prescribed therapy and the chosen surgical tactics, but also by the length of stay in the surgical hospital. Thus, the duration of stay in a surgical hospital in the general cohort of patients with peritonitis was 10 (min - 6; max - 33) days; patients requiring relaparotomy - 15 (min - 9; max - 22) days, much more (p = 0.0217). It was found out that E.coli was more often recorded in combination with Streptococci, Staphylococci, Enterococci and P. aerugenosa. All patients had peritonitis, 22.2% developed postoperative complications. For 62.9% of patients, antibacterial treatment was applied in combination with cefalosporins or fluoroquinolones with metronidazole. Average duration of antibacterial therapy in patients with peritonitis was 5 days, in patients with postoperative complications – 9 days. Complications were registered in patients older than 60 years of age with comorbid conditions. Conclusion. The authors consider expedient to use mini-invasive technologies for the treatment of postoperative complications, taking into account that relaparotomy makes treatment more expensive due to the additional use of antibacterial agents and prolonged stay in the surgical hospital despite recommended antibacterial therapy.