Purulent mediastinitis: microbiological structure of pathogens and choice of the optimal antiseptic for the sanitation of the purulent inflammatory process
DOI:
https://doi.org/10.32782/2415-8127.2026.73.3Keywords:
purulent diseases, surgical treatment, pathogenic microorganisms, antisepticsAbstract
Purulent mediastinitis is characterized by a severe course and occupies a special place among purulent-septic processes, accompanied by high rates of complications and mortality. The relevance of the problem is due to changes in the etiological structure of pathogens, the increase in antibiotic resistance and the need to optimize local antiseptic therapy in the postoperative period.
The aim: to improve the results of treatment of patients with purulent mediastinitis by studying the structure of isolated pathogens and determining the sensitivity of pathogenic microflora to antiseptic agents.
The results of the examination and treatment of 59 patients with purulent mediastinitis who were inpatients during 2020-2025 were analyzed. Microbiological examination of biomaterial (contents of drainages, mediastinal washes, material from postoperative wounds and pleural cavity) was performed according to generally accepted methods with species identification of pathogens. The sensitivity of microorganisms to decamethoxine, octenidine, chlorhexidine and povidone-iodine was determined by the method of two-fold serial dilutions with the establishment of the minimum inhibitory and minimum bactericidal concentrations. Statistical processing was performed using the STATISTICA package, the results are presented in the form of M±σ.
The main causes of purulent mediastinitis were odontogenic phlegmons of the neck (28.8%), ENT-associated phlegmons (23.7%) and damage to the esophagus of various genesis (30.5%). The prevalence of gram-positive microflora (54.33%), among which Staphylococcus aureus dominated, was established. Among gram-negative pathogens, Acinetobacter baumannii and Pseudomonas aeruginosa were most often isolated. A comparative analysis of the sensitivity of microorganisms to antiseptic agents showed that decamethoxine and octenidine have statistically similar pronounced bacteriostatic and bactericidal effects compared to chlorhexidine and povidone-iodine (p<0.05).
The results obtained indicate the feasibility of using decamethoxine and octenidine for local sanitation in purulent mediastinitis, taking into account the structure of pathogens and their sensitivity.
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