The journal Sterilization and Hospital Infections (2008, No. 2 (8)) has published new documents on perioperative antibiotic prophylaxis (Fadeev SB, Tarasenko VS, Stadnikov BA, Bobylev AI, Bobylev A.A. "Perioperative antibiotic prophylaxis of complications purulent inflammatory disease in patients with acute appendicitis and soft tissue phlegmon ", Orenburg). We will approach the part of the work which proposes materials on the phlegmons (abscesses) of the soft tissues.

Antibiotic prophylaxis in surgery (perioperative antibiotic prophylaxis) refers to the use of antimicrobial agents before contamination of microbial tissue in order to avoid the development of infectious complications in the postoperative period. Antibiotic prophylaxis in surgery is a "very short course" of antibiotics that begins immediately before surgery. Perioperative antibiotic prophylaxis is not an attempt to "sterilize" tissue, but an additional measure, performed at a strictly defined time, to reduce microbial contamination of tissue during surgery to a level that cannot be overcome. macro-organism protection mechanisms.

The article authors worked with 225 patients with soft tissue phlegmons in two groups. Unfortunately, the documents do not show exactly how the distribution of patients into groups was carried out. The study group received cefuroxime intravenously during the operation, the control group at the end of the operation. The operating allowance was the same for everyone. The efficacy of the treatment was evaluated by the disappearance of the signs of a systemic inflammatory reaction. As a result, the authors conclude that treatment time is reduced for patients who received an additional antibiotic injection during surgery compared to the control group, namely patients who received an antibiotic injection after surgery. It should be noted that the duration of the operation for this indication under general anesthesia does not exceed 15-30 minutes.

But where is perioperative prophylaxis appropriate? All patients have been reported to have severe signs of a severe soft tissue infection and after surgery have continued to receive antimicrobial therapy for gram-positive flora (therapy has been adjusted based on the results of a microbiological study). Thus, "prophylaxis" was performed for patients already contaminated with the pathogen, with a clear diagnosis. Where is the evaluation of the main objective of prevention - preventing the development of infectious complications? The study does not provide data on the number of patients who underwent revision wounds and repeated operations.

In addition, the presented result of a microbiological study of patients with soft tissue phlegmons causes some confusion. The first by value is S. epidermidis, among the pathogens, a significant percentage is P. aeruginosa, Klebsiella spp. Staphylococci and streptococci are far from the first. How pathogenic in this area S. epidermidis? It should be noted that patients with diabetes mellitus and others who may have unusual pathogens for a number of reasons were excluded from the study. Incidentally, several people with "low compliance" were also excluded from the study, despite the fact that the drug was administered intravenously by medical personnel during or after the operation. In conclusion, the authors indicate that the duration of treatment did not depend so much on the speed of elimination of the pathogen as on the size of the tissue defect. Was it then worth planning such a project and were the two patient groups comparable in size to the soft tissue defects?

Thus, we see a misunderstanding of the essence of antibiotic prophylaxis, an unsuccessful research design, and the results of microbiological tests are questionable. Even the authors themselves, at the beginning of the article using the term "antibiotic prophylaxis", at the end of the article, increasingly use "intraoperative therapy". However, such substitution of concepts is unacceptable. Currently, antibiotic prophylaxis in surgery (perioperative antibiotic prophylaxis) is the standard of care for many surgical procedures and the most common area of antibiotic use in surgery. The likelihood of complications, the success, the cost and the duration of treatment of the patient depend on the correct use of drugs.

Recommendations for the selection of the drug, time, route and frequency of administration have long been developed. The prevention of infectious complications with a large number of operations on the abdominal organs is a solvable task. The treatment of soft tissue infections has its own characteristics and antimicrobial therapy remains one of the main links.