PURULENT INFECTION (nonspecific purulent infection) — the inflammatory process of various localization and character caused by pyogenic microbic flora.
Etiology. Causative agents of a purulent infection are staphylococcus, streptococci, colibacillus, gonokokk, pneumococci, a pyocyanic stick, etc. in pure form or in association with each other (see. Pyogenic bacteria ).
Owing to broad use of antibiotics and their mutagen action species composition of causative agents of a purulent surgical infection changed; in it takes the main place staphylococcus (see) in a monoculture or in various microbic associations. Change of species composition of microbic flora happened along with growth of its antibiotikorezistentnost. Thereof medicinal stability of the stafilokokk allocated at patients with G. and., to penicillin, streptomycin, chlortetracyclin, levomycetinum and erythromycin exceeds 70%, and quite often microflora is polyresistant — steady against big group of the studied antibiotics.
G.'s development and. is defined by interaction macro - and a microorganism. An important factor is character, a dose, virulence of the got microbic flora, a condition of the center of implementation of microorganisms — availability of the necrotic fabrics serving as a medium for microorganisms, a condition of blood circulation, and also immunobiological features of an organism.
And. occupies one of the main places in surgical clinic, makes essence of many diseases and postoperative complications. Patients with pyoinflammatory diseases make V z all surgical patients.
The majority of postoperative complications is connected with a purulent infection. On the materials given by Girkhake and Shvik (F. W. Gierhake, H. G. Schwick, 1971), 42,5% of all lethal outcomes after surgical interventions are connected with pyoinflammatory complications.
There is a certain dependence of nature of pyoinflammatory diseases on age of patients. At young age (17 — 35 years) meet more often phlegmon (see), abscess (see), purulent lymphadenitis (see), mastitis (see), osteomyelitis (see); at the age of 36 — 55 years diseases of an urinary system — a pyelitis prevail, cystitis (see), pyelonephritis (see), paraproctitis (see); 55 years are aged more senior — anthrax (see), necrotic phlegmon, post-injection abscess, etc.
At children the purulent infection proceeds as phlegmon of newborns (see. Phlegmon ), sepsis (see), suppurative diseases of lungs and pleura, acute hematogenous osteomyelitis, staphylococcal peritonitis (see).
G. and. classify by an etiology, localization and a wedge, to a current. On an etiology allocate monoinfection (staphylococcal, streptococcal, collibacillary, proteyny, gonococcal, pneumococcal, etc.) and polyinfection (staphylococcal and collibacillary, staphylococcal and streptococcal, etc.). On localization distinguish G. and. skin, hypodermic cellulose of extremities and trunk; covers of a skull and its contents; necks; chest wall, pleura and lungs; mediastinums; peritoneum and abdominal organs; basin and its bodies; bones and joints. On a wedge, to G.'s current and. can be the acute general (sepsis), acute local (abscess, phlegmon, a furuncle, an anthrax), the chronic general (hroniosepsis), chronic local (abscess, an empyema, osteomyelitis, etc.).
. and. has essential differences at acute and hron, a form and at various localization; to a lesser extent it depends on character of the activator.
For acute G. and. any localization are characteristic fervescence, often gektichesky type, sometimes from oznoba, the tachycardia which sometimes is followed by decrease in the ABP up to a collapse — the symptom complex called by purulent intoxication. A number of laboratory indicators undergoes the changes characteristic of inflammatory reaction of an organism: a leukocytosis with a neutrocytosis and the left band shift, a lymphopenia, an eosinopenia, acceleration of ROE, increase in coagulability of blood and change of its protein fractions, positive reaction on C-reactive protein (see).
Local changes depend on G.'s localization and. E.g., at its localization in skin, hypodermic cellulose and muscles signs of an inflammation are characteristic of it: pain, redness, swelling, increase in local temperature, disturbance of functions.
For hron. And. signs hron, inflammatory process are characteristic: long temperature increase, acceleration of ROE, lymphocytosis, change of protein fractions of blood, etc. At it is long existing hron. And. the amyloidosis of internals can develop (see. Amyloidosis ). Local changes at superficial localization are characterized is long the existing infiltrates, is frequent with existence fistulas (see).
Due to the broad use of antibiotics changed a wedge, a picture G. and., cases of transition of acute forms in chronic became frequent, a recurrence of a disease began to be observed more often. Performing antibiotic treatment without the corresponding indications can shade a wedge, manifestations of a number of the acute surgical diseases demanding the emergency surgical treatment such as purulent appendicitis, empyema of a gall bladder, peritonitis, purulent pleurisy, mastitis that is especially brightly shown at a combination of an antibioticotherapia to treatment by steroid hormones.
Treatment shall combine influence both on an infestant, and on a macroorganism. At local G. and. by surgical intervention it is necessary to provide good outflow of pyoinflammatory exudate.
As antibacterial agents apply antibiotics, nitrofuran drugs, streptocides in combination with proteolytic enzymes. It is necessary to use drugs taking into account sensitivity to them microbic flora. Before data acquisition about an antibiotikochuvstvitelnost of microflora in the presence of indications apply antibiotics of a wide range to an antibioticotherapia. For increase in protective forces of an organism means of active and passive immunization (staphylococcal anatoxin, autovaccines, hyperimmune plasma or serum, specific gamma-globulin, etc.), and also hemotransfusion and its drugs, proteinaceous blood substitutes are shown; with the disintoxication purpose — blood substitutes like Haemodesum, Neocompensanum, etc. In case of heavy G. and. at children make direct hemotransfusion from previously immunizirovanny parents. Early removal of the center of an infection, opening and drainage of abscesses, use of proteinases with the nekrolitichesky purpose is of great importance. From the physiotherapeutic means used in complex therapy of G. and., apply uv radiation, currents of UVCh, an electrophoresis with antiinflammatory drugs and proteolytic enzymes.
Prevention of a purulent surgical infection is carried out by the principle protivoepid, actions — impact on all links epid, chains: a source of an infection — a way of transfer — an organism.
In the epidemiological relation it is necessary to consider that G.'s source and. not only the patient with pyoinflammatory diseases, but also bacillicarriers — personnel of surgical departments is (see. Intrahospital infections ). Influencing a source of an infection, it can be liquidated or isolated, influencing ways of transfer — to block them, and having raised specific immunobiol. reactivity of an organism — to increase resistance of the patient to an infection. In modern conditions there is an imperative need of respect for strict norms and laws asepsises (see). An asepsis — one of the main, most important methods of prevention of an intrahospital purulent infection.
The important place in G.'s prevention and. occupies a duty of surgical departments, operational, dressing. During the work in surgical department with strict isolation of purulent patients and the managed ventilation the frequency of the postoperative wound fever caused by piogenic staphylococcus can be reduced by 3 — 4 times. In G.'s prevention and. in surgery reduction of injury of operation is of great importance.
Bibliography: Purulent surgical infection and fight against it, under the editorship of G. P. Zaytsev, M., 1967; Davydovsky I. V. General pathology of the person, M., 1969; Pods V. I. and Gostishchev V. K. Overcoming antibiotiko-rezistent-nosti pyogenic microbic flora, Surgery, No. 9, page 74, 1973, bibliogr.; Pods V. I., Grigoryan A. V. and Gostishchev V. K. Purulent wound, M., 1975, bibliogr.; Blowers R. Sources and routes of surgical infections, Bull. Soc. int. Chir., v. 30, p. 90, 1971; G i er-h a k e F. W. u. S with h w i with k H. G. Immunologisch Aspekt bei postoperativen Infectionen, ibid., p. 75.
B. I. Struchkov, B. K. Gostishchev.