Kondratiuk V. A microbiological substantiation of a new concept for antimicrobial therapy of battle wounds with infectious and inflammatory complications in the modern armed conflicts

The object of research: the course of infectious complications of the injured militarymen with combat wounds, the healing process of infected combat wounds. The purpose of research: creating a modern concept of antimicrobials administration in the treatment of gunshot and blast wounds by means of bacteriological monitoring of the spectre of the wound microbiota, considering the dynamic changes of its components in the development of infectious complications, and based on the analysis of its sensitivity to antimicrobial drugs. Research methods: Microbiological; experimental (studying the new antimicrobial compositions on laboratory animals); histomorphological (tissues of the wound edges); laboratory (peripheral blood parameters); molecular genetic (detecting the bacterial resistance genes to antibiotics); epidemiological (establishing the patterns of microorganisms spreading); mathematical and statistical. Equipment: An automated bacterial identification system (VITEK® 2 Biomerieux, France); Humanreader photometer (Germany); Codyson CD-7810A ultrasonic bath (China); Söring Sonoca 400 ultrasonic cavitator (Germany); Carl ZEISS Axiostar plus microscope (Microlmaning, Germany). The dissertation is aimed at developing preventive and treatment algorithms for infectious complications of battle wounds based on the results of microbiological and epidemiological monitoring. It has been determined that infectious complications are caused mainly by gram-negative bacilli, which are characterized by multiple resistance to antibiotics. A list of genes encoding resistance enzymes has been identified. The pathogens show the ability to form biofilms, which determines their resistance to antibiotics. The components of biofilms inhibit the inflammatory response of the macroorganism, accelerating the onset of the proliferative phase. To eradicate microorganisms from the wound bed, a depot form of decamethoxine has been proposed, which provides a long-term release of antiseptic into the wound, and restores the effectiveness of systemic antibacterial therapy against resistant strains. The effective antibiotics and their combinations have been recommended, the indications for their appointment and replacement identified; and the basic organizational measures preserving their efficiency in the treatment of infectious complications of wounds have been defined. The extent of implementation: 19 acts of implementation, 4 patents. The field (industry) of use: healthcare (medicine: immunology, infectious diseases, surgery).