Estimation of the effectiveness of decasan, decamethoxin and its composition usage in patients with severe thermal injury

Анотація

Introduction. Nowadays victims with burn trauma are one of the most important categories of patients in the emergent surgery. According to the data of WHO burns happen in 5,6 – 10 % of cases among all kinds of trauma. Purulent-inflammatory complications in these patients are of great importance.The aim was to study microbiological, clinical effectiveness of antiseptics, antimicrobial composition of decamethoxin with modified polysaccharides, antimicrobial materials in prophylaxis and treatment of infectious complications in patients with burn injury. Materials and methods. In the research microbiological study of antimicrobial activity of modern antiseptics, antimicrobial materials against opportunistic pathogens of purulent-inflammatory complications in patients with difficult burn injury and clinical observation of effectiveness of the use of antimicrobial composition (AMC) of decamethoxin (DKM) with carboxymethylamylum, oxyethylcellulose, polyvinilacetate. There were 130 patient with difficult burn injury (the 3rd- 4th stages; injury square – 10,0 – 85,0 % of surface) enrolled in the study. All patients underwent early surgery on the 2nd-3rd day after trauma. Complex intensive care was provided to every patient. Microbiological examinations of patients (100 %) were carried out before antibacterial treatment and every 7 days during treatment. Antimicrobial qualities of antiseptics (decasan, miramistin, chlorhexidine digluconate) and AMC against S. aureus (n 35), S. epidermidis (n 12), Enterococcus spp. (n 9), P. aeruginosa (n 39), A. baumannii (n 54), Proteus spp. (n 16), Enterobacter spp. (n 11), K. pneumoniae (n 12), E. coli (n 9), C. albicans (n 7) were studied according to standard methods. Antimicrobial qualities of dressings, containing antiseptics we studied on clinical strains of S. aureus, E. coli, P. aeruginosa on dense medium, counting diameter of growth delay zones (mm).
Results and discussion. Results of study of sensitivity of Gram-positive and Gram-negative pathogens of purulent-inflammatory complications in patients with severe thermal injury to antiseptics (decasan, miramistin, chlorhexidine) and antimicrobial composition of decamethoxin (AMC) presented advantages of antimicrobial activity of decasan, AMC against S. aureus, S. epidermidis, Enterococcus spp., P. aeruginosa, A. baumannii, Proteus spp., Enterobacter spp., K. pneumoniae, E. coli, C. аlbicans in comparison with miramistin (<0,001), chlorhexidine digluconate (<0,001). Antimicrobial qualities of antimicrobial gauze, impregnated with AMC, against S. аureus (32,4±0,5 mm), E. coli (26,4±0,3 mm), P. aeruginosa (20,8±0,34 mm) were higher than in textile materials containing chlorhexidine. Clinical effectiveness of the use of materials, impregnated with AMC, for prophylaxis and treatment of purulent-inflammatory complications in patients with severe thermal injury was proved. Microbial load of P. aeruginosa in wounds, where gauze with AMC was used, decreased from 7,1 x 107 CFU/ml (before treatment) to 2,9 x 105 CFU/ml (7th day). In control group P. aeruginosa colonized wounds 1 x 108 CFU/ml (before treatment), and 3,2 x 107 CFU/ml (7th day). The same tendency was found for A. baumannii.
Conclusions. Modern antiseptics decasan and AMC have high antimicrobial qualities against Gram-positive (S. aureus, S. epidermidis, Enterococcus spp.), Gram-negative (P. aeruginosa, A. baumannii, Proteus spp., E. coli, K. pneumoniae) bacteria and C. albicans which cause purulent-inflammatory complications in patients with difficult burn injury. AMC of decamethoxin demonstrate higher antimicrobial effect against S. aureus, A. baumannii, P. aeruginosa, Proteus spp., E. coli in comparison with miramistin, chlorhexidine digluconate (р<0,001). AMC using for impregnation of gauze and its use in patients with burns provide high clinical effectiveness in wound infection prophylaxis.