Microbiological monitoring of the uropathogens is an effective "tool" for urinary tract infectious and inflammatory diseases treatment quality improvement. The aim of the article is to determine the range of the urinary tract infectious-inflammatory diseases etiological spectrum groups of pathogens in the child population in Chernivtsi region. Materials and methods. The etiologic spectrum of uropathogens identified in the urine samples of 657 patients who were provided with a specialized medical care in the Nephrology Department of the "Municipal Children's Clinical Hospital", Chernivtsi (2014-2015) was analyzed in order to dynamically control the possible changes of the "urinary tract infections" (UTI) regional etiological structure and antibiotic resistance of pathogens; identification of age and gender differences of urine microbial diversity in the child population in Chernivtsi region (2014-2015) compared with the monitoring data for the 2009-2013 period. Results. A significant difference has been found in the etiological structure of the urine microbial diversity in children with infectious and inflammatory diseases of the urinary tract (Gram-positive cocci-p < 0.05; Enterobacteria-p < 0.01; resident microflorap < 0.01) in comparison with uropathogens extracted in children with urinary tract noninfectious diseases. Administrative and territorial differences have been registered in etiological structure of the urine microbial diversity in children living in the urban areas (p < 0.01) from their peers living in the rural areas. Conclusions. The regional monitoring data showed changes of the urine resident microflora (p < 0.01) without significant changes of etiological spectrum of the UTI pathogens in examined children (0-18 years old) with urinary tract infectious and inflammatory diseases during 2009-2015 in Chernivtsi region. At the same time it as a matter of concern a significant increase in the proportion of "negative results" (no growth) in the urine bacteriological analysis (p < 0.01), which might indirectly indicate the "uncontrolled" use of antibiotics among children in the region.
In the scope of current medical practice the "viewpoint" regarding the growth of antibiotic resistance of microorganisms is a threat to national security. A reasonable use of antibiotics on the basis of uropathogen regional bacterial sensitivity gives the opportunity to "restrain" the growth of antibiotic resistance of microorganisms and increase the effectiveness of the UTI treatment.The aim of the article is to determine the range and dynamics of the antibiotic resistance of major groups of infectious-inflammatory diseases causative agents of the urinary tract in the child population of the Chernivtsi region. Materials and methods.The analysis of etiologic spectrum and antibiotic resistance of uropathogens was conducted and observed in the urine samples of 657 patients who were provided with a specialized medical care in the Nephrology department of the "Municipal Children 's Clinical Hospital", Chernivtsi (2014 with the purpose of the dynamic control of possible changes in the regional antibiotic resistance of pathogens of causative pathogens of the "urinary tract infections" (UTI); identify the age and gender differences of the child population of the Chernivtsi region (2014)(2015) compared to the monitoring data for the period of 2009-2013.Results. When UTI among of the child population of the Chernivtsi region leading etiologic organisms include strains of the family Enterobacteriaceae and uropathogen of the genus Proteus. A "wave-like" curve of the dynamics of antibiotic resistance of Enterobacteriaceae uropathogens with a decreasing tendency to the "drugs of choice" was observed among the child population of the region (2009)(2010)(2011)(2012)(2013)(2014)(2015): penicillin (P < 0.01), cephalosporin II-III generation (P < 0.01) and medicine of the fluoroquinolone series (P < 0.01). A "wave-like" curve of the dynamics of antibiotic resistance of Proteus uropathogens with a decreasing tendency to the "drugs of choice" was observed among the child population of the region (2009)(2010)(2011)(2012)(2013)(2014)(2015): semi-synthetic penicillin (P < 0.1), and medicine of the tetracycline series (P < 0.01). Conclusions.Regional microbiological monitoring of the uropathogens is an effective "tool" in higher quality treatment of infectious and inflammatory diseases of the urinary tract of the child population.Регіональний моніторинг антибіотикорезистентності збудників інфекцій сечової системи серед дитячого населення Чернівецької області Сучасний «погляд» у світовій медичній практиці щодо зростання антибіотикорезистентності мікроорганізмів -загроза національної безпеки. Раціональне використання антибіотиків, на підставі даних про регіональну бактеріальну чутливість уропатогенів, дає можливість «стримувати» зростання антибіотикорезистентності мікроорганізмів і підвищити ефективність лікування інфекційно-запальних захворювань сечової системи.Мета роботи -встановити динаміку антибіотикорезистентності основних груп збудників інфекційно-запальних захворювань сечової системи в дитячого населення Чернівецької області.Мате...
Introduction. Diseases that are accompanied by significant cutaneous-subcutaneous-fascial defects during surgery in children include: pilonidal cyst (PC), spinal hernia (SH), Fournier’s gangrene and wounds. Various methods of surgical treatment of PC consist of the stages: removal of the cyst and covering the wound surface with suturing or leaving the wound surface open. The existing methods of covering a defect in SH in children cannot satisfy surgeons, because they are accompanied by significant tissue tension, which causes complications. Fournier’s gangrene in children is a rare disease with a large area of soft tissue damage. Initial surgical debridement of wounds in childhood requires an individual approach with the choice of the correct method to close the defect. Purpose. To study the possibilities of using the rotation of vascularized cutaneous-subcutaneous-fascial flap (CSFF) for the surgical treatment of superficial defects in children. Materials and methods. The surgical treatment of superficial defects in 73 children in a City Children’s Hospital (Chernivtsi) with PC (29 children), SH (20 children), wounds of the face, limbs and trunk (23 children), Fournier gangrene (1 child) was analyzed. We compared the performing of traditional methods of treatment and rotational methods of using CSFF. Recovery time and postoperative complications were analyzed. Results. By using traditional methods of treating PC, complications were observed in 50%, when using the proposed plastic surgery with rotational CSFF in 6.67%; in case of SH – in 44.44% and 18.18%, with wounds – in 27.27% and 8.33%, respectively. Plastic reconstruction in Fournier’s gangrene recovered on the 40th day of the postoperative period. Conclusion. The use of cutaneous-subcutaneous-fascial rotational flap with perforating vessels surgery allows to reduce the amount of complications after operations for PC, SH, initial surgical debridement of wounds, Fournier’s gangrene. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: cutaneous-subcutaneous-fascial flaps, superficial defects, children.
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