Normal microflora

Domestic and foreign experience shows that when performing antimicrobial efficacy of perioperative protection depends on the risk factors: the patient's condition, pre-, intra-and postoperatively dependent factors (Table 3).

It should be noted that on admission to hospital the patient is faced with the hospital strains. Moreover, by increasing the length of stay in hospital increases the probability of replacing the patient's own microflora in hospital. In this regard, infectious processes, developing in hospitalized patients may be caused by community-acquired and nosocomial microflora [22].

According to the NNIS (USA), as well as domestic researchers the distribution of pathogens isolated in the SSI over the last decade has not changed, despite the fact that these figures in various surgical clinics are different enough diversity [21,22,43,64] .

The most frequently allocated agents are: Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Increasingly important role in the development of SSI were playing antimicrobial resistance pathogens - metitsillinrezistentny S. aureus (MRSA), as well as Candida albicans [3,10,14,31,35,53,71].

Microbial contamination of the wound is unavoidable even with perfect compliance with the rules of asepsis and brand viagra antisepsis, and by the end of surgery in 80-90% of cases, wounds contaminated with various microbial, more often - staphylococci [44].

Biver A. on a large clinical material showed that, despite the contamination of wounds at the end of the operation in 80-90% of cases, purulent complications occur in 2-30% of cases [52]. This is probably due to the fact that the development of SSI content of microbes in the surgical wound shall not be less than 105 [22,38,69].

At the same time Davidovsky IV [15,16] pointed out that the development of infection in the wound, indicating it is not only kind of agent, but the state of microorganism, as well as the functional status of damaged tissues. The author therefore stressed that the guiding motto of surgeons should be "not to fight bacteria in the wound, and the struggle for the purity of anatomical injury.

It should be noted that the pre-and postoperative performance monitoring of major and "minor" risk factors for SSI is useful for two reasons:

- They provide the possibility of stratification by type of operation, making the data of surveillance more intelligible;

- Knowledge of risk factors to specific operations can afford to take determined measures to prevent infection [65].

At the same time, carrying out risk assessment of infectious complications with the use point system can be more precisely judge the effectiveness of antibacterial protection [2].

The most successful was the idea of stratification indicators SSI rate according to the degree of microbial cleanliness of the wound. This classification is able to predict the probability of wound infection, is shown in Table 4 [12,20-22,27,28,44,49,57].

It is well known that the widespread use of broad-spectrum antibiotics affect the bacterial flora, causing selection of resistant populations of the locus of infection or endogenous microflora of the patient. Resistant strains of microorganisms can be transmitted from patient to patient via the hands and the environment in violation of sanitary treatment in a surgical ward. It is known that the patient's stay in a surgical hospital within 48 hours of going on the settlement of its biological econiches (skin, mucous membranes of the airways and gastrointestinal tract) hospital strains of microorganisms.

Recent studies have shown that the normal microflora of the human is an open biocaenosis, which is in dynamic equilibrium with the host organism and its environment consisting of obligate (autochthonous, resident) and transient (random) microorganisms. In most cases, the source of infestation for endogenous infection is the lumen of digestive tract and mucous membranes - habitat automikroflory.

It is known that in the oral cavity revealed over 300 species of microorganisms. In the saliva of their number can reach 109 CFU / ml. The stomach is usually contaminated by microorganisms, ended up with food and saliva from the mouth. Number of micro-organisms is 103 cfu / ml. Duodenum, gaunt and Upper ileum contain less than 104 CFU / ml. In the colon revealed over 400 species of microorganisms. Their number reaches the 1012-14 CFU / ml. They are strict and facultative anaerobes, the residual microflora and various representatives of the family Enterobacteriaseae.

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