LOCAL IMMUNOCORRECTION OF SURGICAL SOFT TISSUE INFECTION IN PATIENTS WITH DIABETES MELLITUS

Abstract

Background. Due to the decrease in the effectiveness of antibiotic therapy, the widespread use of multi-antibiotic-resistant strains of infectious diseases in surgery and the possibility of their epidemic spread an increase in the number of postoperative complications, an increase in the number of immunocompromised persons (drug addicts, patients with chronic alcoholism and diabetes mellitus) - the problem of treating surgical infectious diseases remains extremely relevant. The study of local Immunity is currently receiving a lot of attention.

Material and methods. The results of a comprehensive examination and treatment of 73 patients with surgical soft tissue infection in the department of surgical infection are analyzed. All patients had complaints, anamnesis, and general and local manifestations of the infectious process, the severity of the patient's condition and the presence of systemic inflammatory reaction syndrome were assessed, a comprehensive laboratory examination, a general blood and urine test, a biochemical blood test, and a coagulogram were performed.

Results. The study of the functions of phagocytes with a focus on inflammation (wound) using the autostrain of bacteria - the causative agent of the disease as an object of phagocytosis adequately reflects the level of local cellular anti-infective protection in patients with acute purulent diseases of soft tissues. In patients with acute purulent diseases of soft tissues in the acute period, violations of the effector functions of poly- and mononuclear phagocytes of peripheral blood and the focus of inflammation (depression or dysfunction) are detected,  To a greater extent, expressed in patients against the background of concomitant diabetes mellitus. After drainage of the purulent focus against the background of traditional treatment, this imbalance persists for 13-14 days, which correlates with impaired wound healing.

Conclusion. Local application of the supernatant of activated autologous neutrophils eliminates the existing imbalance of effector functions of phagocytes of both the focus of inflammation and peripheral blood in patients with purulent diseases of soft tissues, however, in patients with concomitant diabetes mellitus, the effect of only local immunocorrection on systemic immunity is insufficient. Local immunocorrection with autologous neutrophylokines helps to reduce the first phase of the wound process, reduce the level of bacterial contamination and accelerate regenerative processes in the wound in patients with acute purulent diseases of soft tissues, including against the background of concomitant diabetes mellitus.

Keywords: Surgical infection of soft tissues, immunological reaction, diabetes mellitus