Sirko A, Yovenko I, Zhyliuk V, Mosentsev M, Pilipenko G
1State Establishment, Dnipropetrovsk Medical Academy, Ministry of Healthcare of Ukraine.
2Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Ukraine.
Georgian Med News. 2019 Sep(294):10-16.
Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.
目的——评估与战斗相关的穿透性颅脑枪伤（PCGW）患者的病原体及其对抗生素治疗（ABT）的敏感性，并制定创伤后脑膜脑炎的治疗建议。我们对2014年5月25日至2017年12月31日期间入住乌克兰第聂伯罗彼得罗夫斯克州梅奇尼科夫第聂伯罗地区临床医院公共机构并相继纳入研究的121例患者的检查和治疗结果进行了前瞻性分析。14例（11.6%）患者诊断为颅内化脓性败血症并发症，其中包括8例单纯性脑膜脑炎、3例脑膜脑炎合并脑室炎、2例脑膜脑炎合并脑室炎和硬膜下积脓以及1例多发性脑脓肿。在大多数与战斗相关的颅脑创伤病例中，感染被认为是医院获得性感染，通常与医疗程序和器械有关。在大多数情况下，一线抗生素的有效性较低，根据世界卫生组织的分类，通常有必要开具广谱ABT，包括那些与二线抗生素和储备药物相关的药物。建议使用初始经验性ABT降阶梯治疗，使用最广谱的药物，主要作为预期革兰氏阳性和革兰氏阴性需氧和厌氧感染病原体联合治疗的一部分。
