Vasilevskay L. Etiological and pathogenetic principles of empirical and directed antibiotic therapy for patients with sepsis.

The Degree Thesis deals with examination of 253 patients with sepsis on the basis of which a deescalation and directed antibiotic therapy has been optimized, which allows to chose an optimum alterna-tive of its application for patients with different forms (stages) of a septic process. Development frequency of microflora antibiotic-resistance determined under different schemes of antibiotics applications shows the following: resistance to semi-synthetic penicillins is 8,7 %; to cephalosporins of the 1st-4th generations - respectively 10,3; 10,4; 8,3; 3,7 % to modern aminoglycosides - 6,2 %; to fluorochinolones - 8,2 %, to carbapenemas - 3,4 %. Correlation ties between effectiveness of the empirical and directed antibiotic therapy and a modified system of points of patients disease seriousness APACHE-II has been determined. The most effective procedure of deescalation and directed antibiotic therapy for each form of a septic process has been optimized. Competence of theoretical provisions which justify prospects of program for complex treatment of sepsis has been proved by a positive effect of its clinical application which provided the reduction of patients' lethal outcomes: in the course of a "triple" regimen of the antibacterial therapy - - 26,2 %; "double" regimen - from 5,8 to 22,8 %; monotherapy - 9,4 %.