Page 14 of 43
The difficult and insufficiently studied question is use of antibiotics for prevention of early complications from an operational wound. From the beginning of broad use of antibiotics in surgical practice there were works on their use in the postoperative period and with the preventive purpose at a deaf seam of a wound (I. G. Bushuyev, 1953; N. I. Blinov, L. V. Grigorieva, 1954; A. M. Martsinkevichus, 1955). In this regard interesting dynamics of suppurations is brought by A. P. Bazhenova (1952) observing 24% of suppurations in 1946 into 1947 — 7%, into 1948 — 0,4%, into 1949 — 0,07% (broad use of penicillin), in 1950 — 2,5%. Apparently, the next year after the beginning of broad use of penicillin with the preventive purpose the number of suppurations increased more than by 30 times. Various offers on improvement of introduction of antibiotics as in the course of an operative measure (K. I. Pikin, 1952; S. I. Kouchner, 1955; S. I. Haygrekht, 1964), and after it (N. P. Sushin et al., 1958) could not improve the general provision. According to modern data, the percent of suppurations is still rather high, reaches 5 — 6% (M. P. Postolov et al., 1971; D. L. Pikovsky, Yu. I. Erofeyev, 1971) also does not tend to decrease.
Moreover, according to Girnace, Schwick (1971), in post-war years is noted growth of number of suppurations after appendectomy from 2,7 to 4,7%, and at persons 50 years — even to 15,4% are more senior.
Among the reasons of increase in purulent complications many researchers see, first, obtusion of attention of surgeons to measures of prevention of a purulent infection in connection with emergence of powerful tools of fight against it and, secondly, emergence of strains of staphylococcus, resistant to the most widespread and widely applied antibiotics (K. E. Rudyak, I. N. Ulanovsky, 1960; L. R. Kryshtalskaya, 1962; A. D. Yukhimets et al., 1972).
In this regard there is very actual a problem of an intrahospital infection and hospitalization. Sources of intrahospital infection are first of all microorganisms from air of operational and other rooms, from objects of leaving, bed linen, tools and a dressing material.
Among various measures of the organizational and medical plan of fight against an intrahospital infection a certain place should be allocated to the termination of broad uncontrolled use of antibiotics including for prevention of suppuration of postoperative wounds. Data of B. Ya. Kiselyov (1968) who studied influence of penicillin on a wound repair after appendectomy in this respect are very indicative. According to the author, use of penicillin with the preventive purpose extended terms of recovery of working capacity in the out-patient period of treatment almost twice. This circumstance is explained by the fact that after an extract from a hospital and the termination of introduction of antibiotics favorable conditions for development of the weakened microorganisms, sluggish suppuration of a postoperative hem are created, is frequent with developing of alloyed fistulas.
In tidy wounds at preventive use of antibiotics tell Dillon about more frequent development of infectious complications, to Postlethwait, Bowling (1969). K. E. Rudyak and I. N. Ulanovsky (1960) pay attention that the staphylococcal infection in the conditions of an antibioticotherapia becomes especially aggressive (virulence of a microbic strain increases). Introduction of antibiotics detains healing and scarring of wounds by suppression of normal migration of leukocytes (L. M. Nedvetskaya et al., 1972). If to it to add danger of development of heavy allergic reactions in the sensibilizirovanny person, up to deaths from an acute anaphylaxis, irrationality, and at times and harm of preventive use of antibiotics after appendectomy with the doubtful purpose to achieve primary healing becomes obvious.
This situation does not mean our helplessness in protection of the patient against an infection at all. Surgical methods of prevention of complications of a wound repair, fight against an intrahospital infection, rational use of antibacterial and other agents allow to improve considerably results of appendectomy, to achieve shortening of terms of recovery. Early diagnosis of a disease, timely hospitalization and technically correct performance of an operative measure is the cornerstone of it.