RESUMO
Several recommendations and data on the treatment of acute necrotizing pancreatitis (ANP) are conflicting and different surgical approaches continue to exist. We conducted a study on 148 patients with ANP, who were divided into two groups: the main group (n = 95) when the tactics of the step-up approach were applied with the principles of the concept of Enhanced Recovery After Surgery (ERAS) in order to determine this approach on effectiveness in reducing complications and 30-day mortality (2017-2022); the comparison group (n = 53) when the same tactic of the treatment was used without ERAS principles (2015-2016). Treatment time for the main group in the intensive care unit was minimized (p ≤ 0.004); it has been shown to reduce the frequency of complications in these patients (p < 0.001) requiring conservative or surgical treatment without general anaesthesia (Clavien-Dindo I-IIIa); no statistically significant differences were observed for the total incidence of Clavien-Dindo IIIb-IVb complications (p > 0.05); the median duration of treatment for patients in the primary group was 23 days, and in the reference group-34 days (p ≤ 0.003). Pancreatic infections have been observed in 92 (62.2%) patients and gram-negative bacteria predominated in the overall pathogen structure with 222 (70.7%) strains. The only evidence of multiple organ failure before (AUC = 0.814) and after surgery (AUC = 0.931) was found to be predictive of mortality. Antibiotic sensitivity of all isolated bacteria better understood local epidemiology and identified the most effective antibiotics when treating patients.
RESUMO
OBJECTIVE: The aim: Explore the antimicrobial properties of lactobacilli's metabolites and combination of lactobacilli's and saccharomycetes' metabolites with different concentrations (in vitro) and to test the effectiveness of samples with minimum inhibitory concentration on infected polyresistant strain P. aeruginosa skin wounds (in vivo) for the possibility of creating prophylactic antimicrobial agents. PATIENTS AND METHODS: Materials and methods: Metabolic complexes (L. rhamnosus GG and S. boulardi) were obtained by culturing lactobacilli or lactobacilli and saccharomycetes in lactobacilli disintegrates. The sensitivity of Pseudomonas aeruginosa PR (in vitro) to them was determined by the microtechnique of serial dilutions in a liquid nutrient medium. In vivo, 0.9 % sodium chloride solution (control) or lactobacillus metabolic complex (experiment, treatment group) was applied to infected skin wounds or, in addition, immediately before the infection, to the wound and then to infected wounds (experiment, prophylactic-treatment group). RESULTS: Results: There was observed the decrease of the infectious process of skin wounds in the prophylactic-treatment group (3.25-3.4 times; p=0.01 related to control samples) compared with the treatment group (2.05-2.25 times; p=0.02) by the wound healing rate (day 5). The healing rate of control wounds (day 11) coincided with the rates of experimental wounds in the prophylactic-treatment group (day 8), indicating that the use of lactobacilli metabolites promotes the acceleration of healing by almost three days. CONCLUSION: Conclusions: Metabolic complexes of probiotic microorganisms are promising for construction on their new class of antimicrobials for the effective pharmacoprophylaxis and pharmacotherapy.