Peculiarities of changes in the specific structure of microflora in the application of vacuum therapy for chronic wounds in patients with diabetic foot syndrome

Abstract

The aim of the work: to study the change in the quantitative and qualitative composition of the microflora in the application of vacuum therapy for chronic wounds in patients with diabetic foot syndrome.

Materials and Methods. Based on the examination and treatment of 122 patients with diabetes complicated by diabetic foot syndrome, who during 2013–2016 were hospitalized in the Clinic of General Surgery of I. Horbachevsky Ternopil State Medical University (Ternopil city municipal hospital Ambulance). Among the examined patients there were 79 (64.8 %) men, and 43 (35.2 %) women, aged from 47 to 69 years. Patients with diabetes milder degree were 19 – mild, 76 – moderate, and 27 – heavy. The stage of compensation for diabetes is diagnosed in 43 patients (35.2 %), subcompensation – in 62 (50.8%), decompensation – in 17 (14%) patients. Patients infected with neuropathic form were 48 (39.3 %), coronary-gangrenous – 74 (60.7 %). All patients underwent general clinical-laboratory and instrumental examination: objective examination, collecting complaints and history of the disease; changes of microhemodynamics lower extremities were studied cytological, microbiological and morphological studies were performed. The therapeutic effect of the vacuum was provided by the apparatus “AGAT-DNIPRO” (80-125 mm Hg). Quantitative and qualitative composition of the microflora was determined by bacteriological examination of the wound exudate on the day of admission, 3, 6, 9 and 14 days of treatment.

Results and Discussion. A microbiological study showed that in 42.6 % there was a combination of 2–3 microorganisms, in 57.4 % – 4–5. Most often, with chronic wounds, gram-positive microflora was sown (62.48 %). Compared with the incidence, the colonization of wound defects significantly decreased (p <0.05–0.01). The same trend was noted in the subsequent treatment periods. From the 6th day, the microbial contamination of chronic wounds decreased and amounted to (3.14 ± 0.47) lg CFU / g. On the 9th day total number of microorganisms was (3.36 ± 0.37) lg CFU / g vs control group (1.94 ± 0.12) lg CFU / g in the intervention group and 14 days of treatment of wounds did not stand out only aerobic bacilli. It was proved that the use of vacuum for treatment of chronic wounds reduces the quantity and species composition of microorganisms, which in turn reduces patient treatment on average (4.1 ± 1.7) days.