Analysis of microflora of wound surfaces in patients with surgical site infection after reconstructive operations due to critical limb ischemia

Abstract

Introduction. Surgical site infection (SSI) is a frequent complication in the postoperative period in patients operated for critical limb ischemia (CLI). The spread of the infection to vascular reconstructions is of particular risk, as it can cause both loss of limb and fatal consequences. Therefore, modern microbiological studies remain extremely relevant in the control of infectious component in patients with SSI. The aim of the study was to analyze the characteristics and rate of microflora culture from the wound surfaces of patients with SSI after reconstructive operations for CLI. Materials and methods. Microbiological study of materials obtained from wound surfaces of 135 patients with SSIs after reconstruction for CLI was conducted. They were divided into 3 groups according to stages in Szilagyi classification. Inoculation of medium, culture, isolation and identification of microorganisms were performed in the laboratory. Study results and their discussion. Twelve types of microbial associations, consisting of 2, 3 and 4 representatives, were detected in the culture. Monocultures from wound surfaces were found in 15.6%, and symbiosis of microbial populations – in 84.4%. An increase in the rate of S.aureus species by 1.5 times was observed in patients with stage III SSI, in comparison with stage II. At stages ІІ and IІІ, the number of S.epidermidis (haem.) cultures increased by 1,3 and 1,6 times, respectively, and a decrease in the rate of S.epidermidis (unhaem.) cultures (p<0.001) in relation to the I stage of SSIs. In three groups, a fairly high incidence of enterococcal culture and the dominance of E.coli among enterobacteria were noted. Ps.aeruginosa was detected in three people. The addition of C.albicans to the bacterial flora was often observed and it rose with the increase of the SSI stage. Conclusions. Changes in the qualitative composition of the microflora from infected wounds, characterized by an increase in the content of pathogenic and opportunistic pathogens, as well as the amount and polymicrobiality of associations of cultured microorganisms, were revealed with the increase of SSI stage based on Szilagyi classification.