DETERMINATION OF MICROFLORA AND SENSITIVITY TO ANTIBACTERIAL MEDICA-TIONS IN PATIENTS WITH ACUTE PURULENT MEDIASTINITIS

Determination of the causative agent of acute purulent mediastinitis (APM) and its sensitivity to antibacterial drugs is one of the decisive factors in the successful treatment of patients. Purpose: to establish a specific spectrum of pathogens of purulent-inflammatory process of mediastinum in various forms of acute purulent mediastinitis and to determine the sensitivity to different groups of antibacterial drugs. Materials and methods. During 2000-2019, 110 patients with APM were in the thoracic department of the Ivano-Frankivsk Regional Clinical Hospital. Results. In microbiological researches it was found that 39 (35.5%) patients with APM were diagnosed with polymicrobial associations of aerobic and anaerobic microorganisms, monoculture - 39 (35.5%), without growth - 32 (29.1%). Gram-negative microorganisms were the main pathogenic flora in the primary APM, indicating exogenous infection of the mediastinum from the lumen of the gastrointestinal tract, namely E. coli, in 12 (33.3%) patients. The microorganisms detected at APM were in general the most sensitive to the 3 groups of antibacterial preparations: carbapenems (Imipenem, Meropenem), fluoroquinolones (Levofloxacin) and cephalosporins of ІІІ-IV generations (Ceftazidim). Discussion of results. In tonsilogenic phlegmons of the neck (NF), the main microorganisms were representatives of the conditionally pathogenic flora - 23 (76.6%) patients, anterobic non-clonid infection in odontogenic NF - 9 patients (81.8%). Summing up the above, we can talk about the absence of specific microorganisms for the APM. The results of the determination of microflora are quite diverse, the identification of the pathogen is often hindered due to the imperfection of selective media that would ensure the growth of all microorganisms. For each type of APM it is possible to predict only the prevalence of certain microorganisms, depending on the cause of APM. Therefore, the definition of microflora and its sensitivity to antibiotics is crucial in the further treatment of patients. Conclusions. Polymicrobial associations of aerobic and anaerobic microorganisms were diagnosed in 39 (35.5%) patients. In the secondary acute purulent mediastinates, the nature of the microflora in the mediastinum was similar to the microbial spectrum, which caused the phlegmon neck in 91% of patients. In the secondary acute purulent mediastinites St. epidermidis - in 17 (23.4%) patients, Streptococcus sp. - in 14 (19.2%); Anaerobic microflora (Bacteroides spp., Fusobacterium spp. and Peptostreptococcus spp.) - in 13 (17.8%) patients were most commonly found. Detected microorganisms with acute purulent mediastinitis were most susceptible to carbapenems (total sensitivity 75.3%), fluoroquinolones (overall sensitivity 64.8%) and cephalosporins III and IV genera (overall sensitivity 64.5%). The results of our studies of the sensitivity of antibacterial agents were taken into account in the treatment of certain forms of acute purulent mediastinitis, which noted the prevalence of certain groups of microorganisms characteristic to primary or secondary forms.