ANAEROBIC INFECTION

ANAEROBIC INFECTION ( wounded ) is an infectious process caused by anaerobes. Characterized by the rapidly emerging and progressive necrosis of tissues with the formation of gases in them and the absence of severe inflammatory phenomena, severe intoxication.

There are two groups of microorganisms - causative agents of anaerobic infection. The first group includes spore forming anaerobes, or clostridia (Clostridium perfringens, Cl., Septicum, Cl., Oedematiens and Cl. His-tolyticum). Wound infection caused by these microorganisms is often referred to as gas gangrene or gas phlegmon . The second group is non-sporeforming, or nonclostridial, anaerobes (bacteroides, fusobacteria, peptostreptococci, peptococci, etc.).

Isolate endogenous and exogenous anaerobic microorganisms. Endogenous anaerobes are an integral part of normal human microflora and are found mainly in the intestine, organs of the genitourinary system. They can also be detected on the surface of the skin, mucous membranes, in the airway. Exogenous anaerobes are found in soil, decomposing organic compounds, on human clothing. The wound infection caused by clostridia has, as a rule, an exogenous origin. Neclostrial anaerobes in most cases are endogenous in nature, being the causative agents of purulent-inflammatory processes in the body.

The possibility of anaerobic infection depends on the amount of anaerobic infection in the wound, the morphological features and virulence of the pathogen, the effect of concomitant microorganisms, etc. Realization of the pathogenic properties of anaerobes is possible with the appropriate state of the organism and only in the presence of tissue sites lacking blood supply, chronic intoxication of the organism, accompanied by a decrease in its protective Forces, and others.

The development of anaerobic infection, both clostridial and nonclostridial, can be fulminant (up to 1 day from the time of injury or surgery), acute (within 3 to 4 days), and subacute (more than 4 days).

With gas gangrene at the beginning of the disease, excitement and anxiety are noted. Typical are complaints of bursting pains in the wound or a feeling of fullness in the limb. Pain is often not removed by narcotic analgesics. The pulse increases to 100-120 beats per minute, the body temperature rises to 39 ° C. Later, icterus appears in the sclera, euphoria increases. Severe intoxication leads to violations of the central nervous system (up to the deep coma), respiratory failure, hemodynamic disorders (reduction of arterial and venous pressure), as well as hepatic renal failure. Infectious-toxic shock often develops. In the blood, anemia and a decrease in hematocrit, moderate leukocytosis , a sharp shift of the leukocyte formula to the left, an increase in ESR are revealed. When examining the wound, pronounced swelling of the tissues is determined, with palpation and percussion - crepitation and tympanic sound. Skin coloring in the affected area with clostridial infection is pale, bluish or bronzed, and its temperature is reduced. A characteristic feature is the spread of edema, and then necrosis at a great distance from the wound. Wounded discharge usually has a serous-bloody character, can be lean and foamy.

Neclostridial anaerobes are often detected in various purulent diseases: purulent pleurisy, abscesses of the lungs, brain, liver, spleen, peritonitis, postnatal or postabortal sepsis, septic thrombophlebitis, etc. The characteristic signs of non-clostridial infection of the open wound are the abundant secretion of pus brown with a sharp fetid odor , Diffuse necrosis of soft tissues, the presence of gas bubbles and droplets of fat in the wound discharge, an increase in body temperature to 39 ° C, chills, increased heart rate to 100-120 beats per minute, severe intoxication, adherence to hepatic renal failure.

At the examination, bacterioscopy of the wound detachable with Gram stain is of particular importance: the presence of "coarse", unevenly thickened rods confirms the diagnosis of clostridial infection, and the abundance of the coccal microflora is characteristic of non-clostridial infection. It is often observed that anaerobic association with aerobic microorganisms occurs as a result of seeding Nutrient media. For planned bacteriological control, the medium (pieces of affected tissue, wound secret, etc.) is sent to the laboratory, following special rules: after puncture, the material obtained is delivered in a syringe or in special transport media, displacing air from them.

The basis for treating the wound with clostridial and non-clostridial infection is surgical intervention: wide dissection of the lesion and excision of necrotic tissues with treatment with antiseptics and adequate drainage. Operative intervention, as a rule, is performed under general anesthesia.

The leading role in the treatment after surgery belongs to antibiotic therapy, which is based on the use of antibiotics, usually a broad spectrum of action: semisynthetic penicillins, cephalosporins, aminoglycosides, etc., as well as drugs that selectively act on anaerobes (clindamycin, metronidazole , etc.). In severe cases, as a rule, the maximum daily doses of drugs are prescribed. In addition, antiseptic agents selectively acting on anaerobes are used: dioxin , dimexide , etc. Infusion therapy (administration of blood products, plasma, blood substitutes, amino acid solutions, etc.), modern methods of detoxification (hemosorption and plasmosorption), immunostimulants (levamisole ), Anabolic hormones, anticoagulants, etc.

With clostridial wound infection, polyvalent anti-gangrenous serum (intravenously administered by drop) is used. Therapeutic dose of 150 000 IU; Before use, the serum is diluted 3 to 5 times with an isotonic sodium chloride solution. It is recommended to administer at least 1 dose of serum per day.

Prevention consists in timely and adequate surgical treatment of wounds, careful observance of aseptic and antiseptic agents during routine surgical interventions, rational use of antibiotics. Sanitary-hygienic regime in the ward where a patient with an anaerobic infection is staying should exclude the possibility of contact spread of pathogens of infection. It is necessary to comply with the relevant requirements for the disinfection of rooms and pressure chambers, toiletries, as well as medical instruments and equipment, dressings,