Affiliation:
1. Military Medical Academy
2. Pokrovskaya Municipal Hospital
3. Nikiforov Russian Center of Emergency and Radiation Medicine
4. Medbazis
Abstract
The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement.
Publisher
FSBEI HE I.P. Pavlov SPbSMU MOH Russia
Reference16 articles.
1. Bisenkov L. N., Chuprina A. P., Gladyshev D. V. Vozmozhnosti torakoskopii pri empieme plevry. Materialy XIII Natsional’nogo kongressa po boleznyam organov dykhaniya. 2003:43. (In Russ.).
2. Ionov P. M., Elikin А. V., Deinega I. V., Yakovlev G. A., Shevtsova М. А. Etiology and clinical forms of lungs and pleura suppurative diseases of HIV-infected patients. Grekov’s Bulletin of Surgery. 2019;178(4):10–14. (In Russ.).
3. Farjah F., Symons R. G., Krishnadasan B., Wood D. E., Flum D. R. Management of pleural space infections: a population-based analysis. J. Thorac. Cardiovasc. Surg. 2007;133(2):346–351.
4. Amarantov A. G., Khorinko A. V., Kosareva P. V. Etiology, clinical picture, diagnosis and treatment of pleural empyema. Current notion (review of literature). Journal of ural medical academic science. 2016;3:61–74. (In Russ.).
5. Petukhov V. I., Rusetskaya M. O. Kliniko-laboratornaya diagnostika i lechenie gnoinykh zabolevanii legkikh i plevry. Vestnik Vitebskogo gosu darstvennogo medicinskogo universiteta. 2009;8(4):1–12. (In Russ.).