DOI: https://doi.org/10.22263/2312-4156.2022.4.59
Y.I. Yarets1,2, I.A. Slavnikov2,3
The use of qualitative and quantitative characteristics of the microbiota of acute wounds for a differentiated approach to the preoperative preparation tactics choice for autodermoplasty
1Republican Scientific and Practical Center for Radiation Medicine and Human Ecology, Gomel, Republic of Belarus
2Gomel State Medical University, Gomel, Republic of Belarus
3The 1st Gomel City Clinical Hospital, Gomel, Republic of Belarus
Vestnik VGMU. 2022;21(4):59-69.
Abstract.
Objectives. To evaluate the possibility of using qualitative and quantitative indicators of microbiological examination of wound discharge to determine a differentiated approach to the choice of tactics for preparing acute wounds for skin grafting (SG).
Material and methods. Qualitative and quantitative indicators of microbiological examination of swabs from acute wounds of 176 patients (wound duration up to 21 days), that was performed in the dynamics of the use of various methods of wound treatment, were analyzed.
Results. The absence of clinical signs of inflammation, a negative culture result substantiated the possibility of performing SG in 23.8% of patients (n=42) after only conservative preparation. The presence of E. faecalis, coagulase-negative staphylococci in wounds determines the possibility of using mechanical debridement in 48.9% of patients (n=86), the effectiveness of which was proved by the successful outcome of SG. Isolation from wounds of S. aureus, P. aeruginosa, A. baumannii, K. pneumoniae, P. mirabilis in the amount of >105 CFU/ml is an indication for the use of ultrasonic and mechanical debridement. Combined debridement was more often performed for wounds lasting from 11 to 21 days (42% vs 20.6% and 21.7% for wounds lasting 5-10 days and up to 4 days, χ2=6.48; p=0.01 ). The skin graft failure (5.1% of patients, n=9) determined the need to take into account isolates of S. aureus, P. aeruginosa, A. baumannii, isolated in the amount of ≤105 CFU/ml.
Conclusions. When determining the procedure for acute wound preparation, it is necessary to take into consideration not only the presence of clinical signs of inflammation, but also the qualitative and quantitative characteristics of the microbiota. Pheno- and genotypic markers reflecting the pathogenic potential of the isolates are additional criteria for choosing the wound debridement method.
Keywords: acute wound, microbiological culture, interpretation of results, pathogenic potential, wound debridement, skin grafting.
Funding: The research was carried out within the frames of the Grant of the President of the Republic of Belarus in healthcare (letter of the Ministry of Health of the Republic of Belarus dated January 20, 2018 №14-12/896) and within the frames of the task of the State Research Program (GPNI) 4 for 2021 – 2025 on the theme “3.20 The study of pathogenic potential of clinically significant bacteria strains to increase the efficiency of infection control system in hospitals”.
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Information about authors:
Y.I. Yarets – Candidate of Medical Sciences, associate professor, head of the Clinical Diagnostic Laboratory, Republican Scientific and Practical Center for Radiation Medicine and Human Ecology, ORCID: https://orcid.org/0000-0001-8879-5079
E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yuliya I. Yarets;
I.A. Slavnikov – Candidate of Medical Sciences, associate professor of the Chair of Surgical Diseases No. 2, Gomel State Medical University, ORCID: https://orcid.org/0000-0001-6431-4090
