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Дисс.....канд. мед. наук // Шамсиев ЖА-Автореф. канд. дисс-Ташкент, 2003. 23 с.,
2003.
28. Юсупов Ш.А., Исламова Д.С., Гаффаров У.Б. Структура патологии гастродуоденальной зоны у детей с дискинезией желчного пузыря // Ученые записки Орловского государственного университета. Серия: Естественные, технические и медицинские науки, 2014. Т. 2. № 7. С. 73-74.
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FEATURES OF MICROFLORA IN THE ETIOLOGICAL STRUCTURE OF DIFFUSE APPENDICULAR PERITONITIS Djalolov D.A.1, Abduvoyitov B.B.2, Khasanov A.B.3, Shavazi R.N.4
1Djalolov Davlatshokh Abduvokhidovich - Student; 2Abduvoyitov Bobur Bahodirovich- Student; 3Khasanov Aziz Batirovich - Student; 4Shavazi Ramiz Nuralievich - Student, DEPARTMENT OF PEDIATRIC SURGERY,
MEDICAL SCHOOL, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the main role in the pathogenesis of peritonitis belongs to the bacterial factor -microbial seeding of the abdominal cavity and the state of immunoreactivity of the organism, which determines the rate of generalization of the process caused by the action of bacterial endo-and exotoxins. The character and severity of the changes depend on the severity of the microbial aggression, the prevalence and duration of the pathological process.
Keywords: diffuse appendicular peritonitis, microflora, exudate, antibacterial therapy, sensitivity to antibiotics.
According to the World Health Organization, "operations for acute appendicitis occupy a leading position in the structure of emergency abdominal operations performed on children, and account for more than 70% of all surgical interventions" [2, 5, 10, 11, 15]. According to world statistics, the total incidence of appendicitis ranges from 3 to 6 per 1000 children with
a peak in incidence between the ages of 9 and 12 years [1, 5, 9, 13, 18]. "Peritonitis on the background of destructive forms of appendicitis in children develops 8 times more often than in adults, and its generalized forms are found 2.5 times more often than local ones." Despite advances in the diagnosis of acute appendicitis, the incidence of its destructive forms ranges from 20 to 74% [2, 6, 11, 17]. The successes of modern medicine have given surgeons a number of effective methods to save the lives of patients with peritonitis [3, 4, 7, 8, 12, 14, 16]. However, the number of postoperative complications in the last decade has remained at the level of 10-15% and has no tendency to decrease. Moreover, the development of these complications remains unpredictable and, therefore, insufficiently manageable process. In this regard, the further improvement of surgical tactics in children with destructive forms of appendicitis remains a priority.
The character of the microflora of the exudate from the abdominal cavity with diffuse appendicular peritonitis (DAP) was studied in 402 patients. It has been established that E. coli (Escherichia colli) occupies a leading place in the etiological structure of peritonitis -in 331 (82.3%) patients; staphylococci and bacteroids were found in 25.4% and 24.6% of cases, respectively. In rare cases, the growth of Pseudomonas Aeruginosa, Proteus, Klebsiella, Enterobacter, Fusobacterium; as a reason, two children were diagnosed with tuberculous appendicitis; in 34 (8.5%) patients with RAP, there was no growth of microflora (Table 1).
Table 1.The species structure of the microflora of the exudate from the abdominal cavity in children
with DAP, n=402
Typeofmicroflora Numberofpatients
abs. %
Gram-negativeaerobes
Escherichiacoli 331 82,3
PseudomonasAeruginosa 4 1,0
Proteus 8 2,0
Klebsiella 3 0,7
Enterobacter 6 1,5
Gram-po sitiveaerobes
Staphylococcus 102 25,4
Enterococcus spp. 68 16,9
Gram-negativeanaerobes
Bacteroides 99 24,6
Fusobacterium 8 2,0
Specificmicroflora
Str. Pyogenes 42 10,4
Mycobacterium tuberculosis 2 0,5
Combinations 70 17,4
Nogrowth 34 8,5
A study of the sensitivity of seeded microflora to 16 most common antibiotics showed that over 60% of the isolated E. coli strains were sensitive to only 4 of 16 antibiotics: ofloxacin (91.3%), cefotaxime (83.2%), cefamisin (79.2%) and polymyxin (68.8%).
Sensitivity to streptomycin was detected only in 52% of cases, which indicates the depleting resource of using this drug in severe inflammatory diseases. The sensitivity to chloramphenicol was 27.8%, to erythromycin - 3.2%, oxacillin - 5.2% of cases.
Antibacterial therapy was started within the first hour after the diagnosis of DAP. Monotherapywas performed with ofloxacin, cefotaxime, cefamisin. Combination therapy included metronidazole (to suppress anaerobic flora) in combination with cefotaxime or cefamisin. The criteria for the effectiveness of antibiotic therapy were considered: positive dynamics in the condition of patients during the first three days after surgery (decrease and normalization of body temperature, reduction of symptoms of intoxication, the appearance of bowel motility and stool motility). In the absence of the effect of antibiotic therapy for 48-72 hours, the drug was replaced by antibacterial therapy, which was carried out taking into account the sensitivity of the microflora.
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