2 research outputs found
Β«ΠΠ΅ΠΎΠΆΠΈΠ΄Π°Π½Π½ΡΠ΅Β» ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ ΡΠ΅Π²ΠΈΠ·ΠΈΡΡ
Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight.
The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology.
Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection.
Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out.
Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ°Π½Π½ΡΠ΅ ΠΌΠΈΡΠΎΠ²ΡΡ
ΡΠ΅Π³ΠΈΡΡΡΠΎΠ² Π°ΡΡΡΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠΈ ΡΡΡΡΠ°Π²ΠΎΠ² ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ, ΡΡΠΎ ΠΎΠΊΠΎΠ»ΠΎ 12% ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΎΠ² ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²ΠΎΠ² ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π°ΡΡΡΡ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΡΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°ΠΌ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 10 Π»Π΅Ρ ΠΏΠΎΡΠ»Π΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. ΠΠΈΠ΄ΠΈΡΡΡΡΠ°Ρ ΠΏΡΠΈΡΠΈΠ½Π° ΡΠ΅Π²ΠΈΠ·ΠΈΠΉ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ°ΡΡΠ°ΡΡΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ², ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½Π°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ (ΠΠΠ). Π§Π°ΡΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, Π² Ρ.Ρ. ΡΠ²ΡΠ·Π°Π½Π½ΡΡ
Ρ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΡΠΈΡΠΈΠ½Π°ΠΌΠΈ, ΠΎΡΡΠ°Π΅ΡΡΡ Π²Π½Π΅ ΠΏΠΎΠ»Ρ Π·ΡΠ΅Π½ΠΈΡ Π²ΡΠ°ΡΠ΅ΠΉ. Π¦Π΅Π»ΡΡ ΡΠ°Π±ΠΎΡΡ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΡΠ°ΡΡΠΎΡΡ Π½Π΅ΠΎΠΆΠΈΠ΄Π°Π½Π½ΡΡ
ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ ΠΏΡΠΈ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
ΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ², Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΠΎΠΌ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π»ΡΠ±ΠΎΠΉ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 839 ΡΠ»ΡΡΠ°Π΅Π² ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ (ΠΠ‘) ΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ (Π’ΠΠ‘) ΡΡΡΡΠ°Π²ΠΎΠ², Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ 485 Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅Π²ΠΈΠ·ΠΈΠΉ Ρ 450 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ, ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ, Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠΉ (ΠΎΠ±ΡΠΈΠΉ ΠΈ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ·Ρ ΠΊΡΠΎΠ²ΠΈ, ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠ³ΡΠ°ΠΌΠΌΠ°) ΠΌΠ΅ΡΠΎΠ΄Ρ, Π°Π½Π°Π»ΠΈΠ· ΡΠΈΠ½ΠΎΠ²ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΆΠΈΠ΄ΠΊΠΎΡΡΠΈ ΠΈ ΠΌΠΈΠΊΡΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ½ΠΊΡΠ°ΡΠΎΠ², Π² Ρ.Ρ. ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΠΎΡΠ΅Π½ΠΊΠΈ Π½Π°Π»ΠΈΡΠΈΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΡΠ° ICM ΠΈ EBJIS (ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΡΡΠ²Π° ΠΏΠΎ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠΌ ΠΊΠΎΡΡΠ΅ΠΉ ΠΈ ΡΡΡΡΠ°Π²ΠΎΠ²). Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 61,7 Π³ΠΎΠ΄Π°. ΠΠ° Π’ΠΠ‘ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ 59,4% ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ, Π½Π° ΠΠ‘ 40,6%. Π ΠΎΡΡ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΎΠ² Π² ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ Π±ΠΈΠΎΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π΅ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½ Π² 2,08% Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ: Ρ 10 ΠΈΠ· 287 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ² ΠΈ Π½ΠΈ Π² ΠΎΠ΄Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΠΈΠ· 198 ΡΠ΅Π²ΠΈΠ·ΠΈΠΉ ΠΊΠΎΠ»Π΅Π½Π½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ². Π 8 ΠΈΠ· 10 ΡΠ»ΡΡΠ°Π΅Π² Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»ΡΠΌΠΈ Π±ΡΠ»ΠΈ ΠΊΠΎΠ°Π³ΡΠ»Π°Π·ΠΎ-Π½Π΅Π³Π°ΡΠΈΠ²Π½ΡΠ΅ ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠΈ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π² 6 MRSE; Π² Π΄Π²ΡΡ
ΡΠ»ΡΡΠ°ΡΡ
Π°Π½Π°ΡΡΠΎΠ±Π½ΡΠ΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ. ΠΡΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Ρ ΠΎΠ΄Π½ΠΎΡΡΠ°ΠΏΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ. ΠΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π½ΠΎΠΉ ΠΠΠ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ½Π°Ρ Π°Π½ΡΠΈΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠ° ΡΡΠ°ΠΏΠ΅ ΠΊΠ°ΡΠ°ΠΌΠ½Π΅Π·Π° Π² ΠΎΠ΄Π½ΠΎΠΌ ΠΈΠ· 10 Π²ΡΡΠ²Π»Π΅Π½Π½ΡΡ
ΡΠ»ΡΡΠ°Π΅Π² ΠΠΠ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»Π°Π³Π°Π»Π°ΡΡ ΡΠ΅ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, ΠΏΠ°ΡΠΈΠ΅Π½Ρ Π½Π° ΡΠ΅Π²ΠΈΠ·ΠΈΡ Π½Π΅ ΡΠ²ΠΈΠ»ΡΡ. ΠΡΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ 63% ΠΈΠ· Π³ΡΡΠΏΠΏΡ ΠΎΡΡΠ°Π»ΡΠ½ΡΡ
(Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
) 470 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² 4 ΡΠ»ΡΡΠ°ΡΡ
ΡΠ°Π·Π²ΠΈΠ»Π°ΡΡ ΠΠΠ , ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Ρ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΡΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π§Π°ΡΡΠΎΡΠ° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ, ΡΠ»ΡΡΠ°ΠΉΠ½ΠΎ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π½ΡΡ
ΠΏΡΠΈ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅Π²ΠΈΠ·ΠΈΡΡ
ΠΊΡΡΠΏΠ½ΡΡ
ΡΡΡΡΠ°Π²ΠΎΠ², ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° Π² 2,08%. Π’ΡΠ΅Ρ
ΠΊΡΠ°ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ½ΠΊΡΠ°ΡΠΎΠ² ΡΡΡΡΠ°Π²Π°, Π² Ρ.Ρ. ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
, ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΠΠ ΠΏΡΠΈ Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΠ·Π±ΡΠ°ΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ ΡΡΠ°ΠΏΠ½ΠΎΡΡΡ ΡΠ΅Π²ΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠΉ ΠΎΠΏΡΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π½ΡΡ
ΡΠ»ΡΡΠ°ΡΡ
ΠΏΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΠΠ Π²ΡΠΏΠΎΠ»Π½ΡΡΡ ΠΎΠ΄Π½ΠΎΡΡΠ°ΠΏΠ½ΠΎΠ΅ ΡΠ΅ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅
ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ² Ρ ΠΏΠΎΠΊΡΡΡΠΈΠ΅ΠΌ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π΄Π²ΡΠΌΠ΅ΡΠ½ΠΎ-ΡΠΏΠΎΡΡΠ΄ΠΎΡΠ΅Π½Π½ΠΎΠ³ΠΎ Π»ΠΈΠ½Π΅ΠΉΠ½ΠΎ-ΡΠ΅ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΠ³Π»Π΅ΡΠΎΠ΄Π°, Π»Π΅Π³ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π±ΡΠΎΠΌ, Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ
Relevance. Formation of pan-resistance microorganisms, microbial biofilms on implants and recurrent infection rate stimulate the search for optimal prosthesis materials for treatment of periprosthetic infection (PJI). Purpose of the study β to compare the efficiency of two stage PJI treatment with simultaneous implantation of a spacer in combination with implants with silver-doped coatings based on two-dimensionally ordered linear chain carbon (TDOLCC+Ag) during the first stage and the conventional revision with a spacer only. Materials and methods. The study included 72 patients with PJI of the knee (n = 42) and hip (n = 30) joints. Control group (conventional revision) consisted of 35 patients and the main group (TDOLCC+Ag coated implant incorporated in a spacer) β 37 patients. Mean age of the patients was 61 years. Temporary components were replaced by the final components during revision at the second stage. Evaluation methods: clinical, X-ray, laboratory, microbiological and follow up history. Results. Inflammation markers and synovial fluid cytosis in the groups at the first revision stage featured equal high base values. During the second stage leucocyte count and cytosis reached normal values, ESR decreased twofold in both groups, CRP decreased five times in the main group. Throat and nasal swabs demonstrated growth of Staphylococcus aureus at 24,3-32,4% in both groups. The leading inducer of PJI was staphylococcal flora with MRSA share of 7,1% and MRSE β from 62,5 to 66,7%. End-points of evaluating treatment outcomes were revision spacer implantation at the second stage of sanation and recurrent PJI. Control group featured implantation of more revision spacers (5) as compared to the main group (1) after the treatment. Two recurrent PJIs were reported for the control group in 11 months while no recurrent infection was reported for the main group. Conclusion. The study demonstrated statistically significant improvement in the outcomes of PJI treatment by spacers with implants coated by TDOLCC+Ag as compared to the conventional treatment option.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. Π€ΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ°Π½ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΎΠ², ΠΌΠΈΠΊΡΠΎΠ±Π½ΡΡ
Π±ΠΈΠΎΠΏΠ»Π΅Π½ΠΎΠΊ Π½Π° ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·Π°Ρ
, ΡΠ°ΡΡΠΎΡΠ° ΡΠ΅ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°ΡΡ ΠΏΠΎΠΈΡΠΊ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ
ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»ΠΎΠ² ΡΠ½Π΄ΠΎΠΏΡΠΎΡΠ΅Π·ΠΎΠ² Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΠΈΠΏΡΠΎΡΠ΅Π·Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ (ΠΠΠ). Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΡΡΠ°Π²Π½ΠΈΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ Ρ ΡΡΡΠ°Π½ΠΎΠ²ΠΊΠΎΠΉ Π½Π° ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΡΠΎ ΡΠΏΠ΅ΠΉΡΠ΅ΡΠΎΠΌ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠ², ΠΏΠΎΠΊΡΡΡΡΡ
Π΄Π²ΡΠΌΠ΅ΡΠ½ΠΎ-ΡΠΏΠΎΡΡΠ΄ΠΎΡΠ΅Π½Π½ΡΠΌ Π»ΠΈΠ½Π΅ΠΉΠ½ΠΎ-ΡΠ΅ΠΏΠΎΡΠ΅ΡΠ½ΡΠΌ Π»Π΅Π³ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΡΠ΅ΡΠ΅Π±ΡΠΎΠΌ ΡΠ³Π»Π΅ΡΠΎΠ΄ΠΎΠΌ (ΠΠ£ ΠΠ¦Π£+Ag), ΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π² Ρ
ΠΎΠ΄Π΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ ΡΠΎΠ»ΡΠΊΠΎ ΡΠΏΠ΅ΠΉΡΠ΅ΡΠ°. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 72 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΠΠ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ (n = 42) ΠΈ ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠ³ΠΎ (n = 30) ΡΡΡΡΠ°Π²ΠΎΠ². ΠΠΎΠ½ΡΡΠΎΠ»ΡΠ½Π°Ρ Π³ΡΡΠΏΠΏΠ° (ΡΡΠ°Π½Π΄Π°ΡΡΠ½Π°Ρ ΡΠ΅Π²ΠΈΠ·ΠΈΡ) β 35 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΎΡΠ½ΠΎΠ²Π½Π°Ρ (ΠΠ£ ΠΠ¦Π£+Ag ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°Ρ Π² ΡΠΎΡΡΠ°Π²Π΅ ΡΠΏΠ΅ΠΉΡΠ΅ΡΠ°) Π³ΡΡΠΏΠΏΠ° β 37 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² β 61 Π³ΠΎΠ΄. Π ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
Π½Π° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΡ Π·Π°ΠΌΠ΅Π½ΡΠ»ΠΈ Π½Π° ΠΏΠΎΡΡΠΎΡΠ½Π½ΡΠ΅. ΠΠ΅ΡΠΎΠ΄Ρ ΠΎΡΠ΅Π½ΠΊΠΈ: ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ, ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ, Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠΉ, ΠΌΠΈΠΊΡΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ, ΠΊΠ°ΡΠ°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ°ΡΠΊΠ΅ΡΡ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΈ ΡΠΈΡΠΎΠ· ΡΠΈΠ½ΠΎΠ²ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΆΠΈΠ΄ΠΊΠΎΡΡΠΈ Π² Π³ΡΡΠΏΠΏΠ°Ρ
Π½Π° ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ΅Π²ΠΈΠ·ΠΈΠΈ ΠΈΠΌΠ΅Π»ΠΈ Π²ΡΡΠΎΠΊΠΈΠ΅ ΡΠ°Π²Π½ΠΎΡΠ΅Π½Π½ΡΠ΅ ΡΡΠ°ΡΡΠΎΠ²ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ. ΠΠ° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΡ ΠΈ ΡΠΈΡΠΎΠ· Π΄ΠΎΡΡΠΈΠ³Π»ΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΡ
ΡΠΈΡΡ, Π‘ΠΠ Π±ΡΠ»Π° ΡΠ½ΠΈΠΆΠ΅Π½Π° Π² ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
Π² 2 ΡΠ°Π·Π°, Π‘Π Π β Π² 5 ΡΠ°Π· Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠ°Π·ΠΊΠΎΠ² ΠΈΠ· Π·Π΅Π²Π° ΠΈ Π½ΠΎΡΠ° Π²ΡΡΠ²ΠΈΠ»ΠΎ ΡΠΎΡΡ Staphylococcus aureus Π² 24,3β32,4% Π² ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
. ΠΠ΅Π΄ΡΡΠΈΠΉ Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»Ρ ΠΠΠ β ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠΎΠ²Π°Ρ ΡΠ»ΠΎΡΠ°, Π΄ΠΎΠ»Ρ MRSA Π² ΡΡΡΡΠΊΡΡΡΠ΅ ΠΊΠΎΡΠΎΡΠΎΠΉ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° ΠΏΠΎ 7,1%, MRSE β ΠΎΡ 62,5 Π΄ΠΎ 66,7%. ΠΠΎΠ½Π΅ΡΠ½ΡΠ΅ ΡΠΎΡΠΊΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ° Π»Π΅ΡΠ΅Π½ΠΈΡ β ΡΠ΅ΡΠΏΠ΅ΠΉΡΠ΅Ρ Π½Π° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ°Π½Π°ΡΠΈΠΈ, Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΠ΅ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΠΠ. Π ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠΎΡΠ»Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΡΠ»ΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ Π±ΠΎΠ»ΡΡΠ΅ ΡΠ΅ΡΠΏΠ΅ΠΉΡΠ΅ΡΠΎΠ² (5), ΡΠ΅ΠΌ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ (1). Π ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ Π±ΡΠ»ΠΎ Π΄Π²Π° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΠΠ ΡΠ΅ΡΠ΅Π· 11 ΠΌΠ΅Ρ., Π² ΡΠΎ Π²ΡΠ΅ΠΌΡ ΠΊΠ°ΠΊ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΡΠ°ΠΊΠΈΡ
ΡΠ»ΡΡΠ°Π΅Π² Π½Π΅ Π±ΡΠ»ΠΎ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π»ΡΡΡΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΏΠ΅ΠΉΡΠ΅ΡΠΎΠ² Ρ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠ°ΠΌΠΈ, ΠΏΠΎΠΊΡΡΡΡΠΌΠΈ ΠΠ£-ΠΠ¦Π£+Ag, ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΎΠΉ Π»Π΅ΡΠ΅Π½ΠΈΡ.ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π΄Π°Π»ΠΈ Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΠ½ΠΎΠ΅ ΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΡΠΎΠ³Π»Π°ΡΠΈΠ΅ Π½Π° ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ. ΠΠΎΠ»ΡΡΠ΅Π½ΠΎ ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π»ΠΎΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΈΡΠ΅ΡΠ°. ΠΠΎΠ½ΡΠ»ΠΈΠΊΡ ΠΈΠ½ΡΠ΅ΡΠ΅ΡΠΎΠ²: Π½Π΅ Π·Π°ΡΠ²Π»Π΅Π½