Acute anaerobic surgical infection. What is anaerobic infection

Anaerobic infection is one of the types of wound infection and belongs to the most severe complications of injuries: compression syndrome, frostbite, wounds, burns, etc. The causative agents of anaerobic infection are gram-negative bacteria (anaerobic gram-negative bacilli, AGOB) that live in conditions of severely limited or completely absent oxygen access. The toxins released by anaerobic bacteria are very aggressive, highly penetrating and infect vital organs.

Regardless of the localization of the pathological process, anaerobic infection is initially considered as generalized. In addition to surgeons and traumatologists in clinical practice, anaerobic infection is encountered by doctors of various specialties: gynecologists, pediatricians, dentists, pulmonologists and many others. According to statistics, anaerobes are found in 30% of cases of the formation of purulent foci, however, the exact proportion of complications provoked by the development of anaerobes has not been determined.

Causes of anaerobic infection

Anaerobic bacteria are classified as conditionally pathogenic and are part of the normal microflora of the mucous membranes, digestive and genitourinary systems and skin. Under conditions that provoke their uncontrolled reproduction, endogenous anaerobic infection develops. Anaerobic bacteria that live in decaying organic debris and soil, when injected into open wounds, cause exogenous anaerobic infection.

In relation to oxygen, anaerobic bacteria are divided into facultative, microaerophilic and obligate. Facultative anaerobes can develop both under normal conditions and in the absence of oxygen. This group includes staphylococci, Escherichia coli, streptococci, Shigella and a number of others. Microaerophilic bacteria are an intermediate link between aerobic and anaerobic bacteria, oxygen is needed for their vital activity, but in small quantities.

Among obligate anaerobes, there are clostridial and non-clostridial microorganisms. Clostridial infections are exogenous (external). These are botulism, gas gangrene, tetanus, foodborne diseases. Representatives of non-clostridial anaerobes are the causative agents of endogenous pyoinflammatory processes such as peritonitis, abscesses, sepsis, phlegmon, etc.

The development of anaerobic infection is facilitated by tissue damage, which creates the possibility of penetration of the pathogen into the body, a state of immunodeficiency, massive bleeding, necrotic processes, ischemia, and some chronic diseases. Potential hazard represent invasive manipulations (tooth extraction, biopsy, etc.), surgical interventions. Anaerobic infections can develop due to contamination of wounds with earth or other foreign bodies entering the wound, against the background of traumatic and hypovolemic shock, irrational antibiotic therapy, which suppresses the development of normal microflora.

Characteristics (types), pathogens

Strictly speaking, anaerobic infections should include pathological processes caused by the vital activity of obligate anaerobes and microaerophilic organisms. The mechanisms of development of lesions caused by facultative anaerobes are somewhat different from the typical anaerobic, but both types of infectious processes are clinically very similar.

Among the most common causative agents of anaerobic infection;

• clostridia;
• propionibacteria;
• bifidobacteria;
• peptococci;
• peptostreptococci;
• sarcins;
• bacteroids;
• fusobacteria.

In the overwhelming majority of anaerobic infectious processes occur with the joint participation of anaerobic and aerobic bacteria, primarily enterobacteria, streptococci and staphylococci.

The most complete classification of anaerobic infections, optimally suitable for use in clinical practice, was developed by A.P. Kolesov.

According to microbial etiology, clostridial and non-clostridial infectious processes are distinguished. Non-clostridial, in turn, are subdivided into peptococcal, fusobacterial, bifidobacterial, etc.

According to the source of infection, anaerobic infections are divided into endogenous and exogenous.

According to the species composition of pathogens, infections are divided into monobacterial, polybacterial and mixed. Monobacterial infections are quite rare; in the overwhelming majority of cases, a polybacterial or mixed pathological process develops. Mixed refers to infections caused by the association of anaerobic and aerobic bacteria.

According to the localization of lesions, infections of bones, soft tissues, serous cavities, bloodstream, internal organs.

Based on the prevalence of the process, there are:

• local (limited, local);
• regional (unlimited, prone to proliferation);
• generalized or systemic.

Depending on the origin, the infection can be community-acquired or nosocomial.

Due to the occurrence of anaerobic infections, there are spontaneous, traumatic and iatrogenic infections.

Symptoms and signs

Anaerobic infections of various origins have a number of things in common clinical signs... They are characterized by an acute onset accompanied by an increase in local and general symptoms. Anaerobic infections can develop within a few hours, the average incubation period is 3 days.

With anaerobic infections, the symptom of general intoxication prevails over the manifestations of the inflammatory process at the site of infection. The deterioration of the patient's condition due to the developing endotoxicosis often occurs before the appearance of visible signs of a local inflammatory process. Among the symptoms of endotoxicosis:

• headache;
• general weakness;
• inhibition of reactions;
• nausea;
• tachycardia;
• fever;
• chills;
• rapid breathing;
• cyanosis of the limbs;
• hemolytic anemia.

Early local symptoms of anaerobic wound infection:

• bursting severe pain;
• crepitus of soft tissues;
• emphysema.

The pains accompanying the development of anaerobic infection are not relieved by analgesics, including narcotic ones. The patient's body temperature rises sharply, the pulse quickens to 100-120 beats per minute.

A liquid purulent or hemorrhagic exudate emerges from the wound, unevenly colored, with gas bubbles and fatty blotches. Odor - putrid, indicating the formation of methane, nitrogen and hydrogen. The wound contains gray-brown or gray-green tissue. With the development of intoxication, disorders of the central nervous system occur, up to coma, blood pressure decreases. Against the background of anaerobic infection, severe sepsis, multiple organ failure, infectious-toxic shock, leading to death, may develop.

Non-clostridial pathological processes are indicated by the release of brown pus and diffuse tissue necrosis.

Clostridial and non-clostridial anaerobic infections can occur in a fulminant, acute or subacute form. Lightning-fast development is said if the infection develops within the first 24 hours after surgery or injury; an infectious process that develops within 4 days is called acute; the development of the subacute process is delayed for more than 4 days.

Diagnostics

The peculiarities of the development of anaerobic infections often leave doctors no choice but to diagnose pathology based on clinical data. The diagnosis is supported by a fetid odor, tissue necrosis, and localization of the infectious focus. It should be noted that with subacute development of infection, the smell does not appear immediately. Gas accumulates in the affected tissues. Indirectly confirms the diagnosis of the ineffectiveness of a number of antibiotics.

A sample for bacteriological research should be taken directly from the site of infection. In this case, it is important to exclude contact of the taken material with air.

Biological materials obtained by puncture (blood, urine, cerebrospinal fluid) and tissue fragments obtained by puncture conicotomy are suitable for the detection of anaerobes. The material intended for research must be delivered to the laboratory as quickly as possible, since obligate anaerobes die when exposed to oxygen and are displaced by microaerophilic or facultative anaerobes.

Treatment of anaerobic infection

The treatment of anaerobic infection requires an integrated approach, including surgery and conservative treatment. Surgical intervention when an anaerobic pathological process is detected should be performed without delay, since the chances of saving the patient's life are rapidly decreasing. Surgical treatment is reduced to the disclosure of the infectious focus, excision of necrotic tissue, open drainage of the wound with washing with antiseptic solutions. Depending on the further course of the disease, the need for repeated surgical intervention is not excluded.

In the most severe cases, it is necessary to resort to disarticulation or amputation of the affected limbs. This is the most radical method of fighting anaerobic infection and is used in extreme cases.

Conservative general therapy is aimed at increasing the body's resistance, suppressing the vital activity of the infectious agent, and detoxifying the body. The patient is prescribed broad-spectrum antibiotics and intensive infusion therapy. If necessary, antigangrenous antitoxic serum is used. Extracorporeal hemocorrection, hyperbaric oxygenation, UFOK are performed.

Forecast

The prognosis is careful, since the outcome of anaerobic infection depends on the timeliness of detection and initiation of treatment, as well as the clinical form of pathology. In some forms of anaerobic infection, death occurs in more than 20% of cases.

Prevention

TO preventive measures includes the removal of foreign bodies from the wound, strict implementation of antiseptic and aseptic measures during operations, timely PHO woundscorresponding to the patient's condition. With a high risk of anaerobic infection, the patient is prescribed antimicrobial and immune-strengthening treatment in the postoperative period.

Which doctor to contact

The main treatment for anaerobic pathologies is surgical. If an anaerobic infection is suspected, a surgeon should be consulted immediately.

Anaerobic infection is a rapidly developing pathogenic process that affects various organs and tissues in the body and is often fatal. It affects all people, regardless of gender or age. Timely diagnosis and treatment can save a person's life.

What it is?

Anaerobic infection is an infectious disease that occurs as a complication of various injuries. Its pathogens are spore-forming or non-spore-forming microorganisms that thrive in an oxygen-free environment or with a small amount of oxygen.

Anaerobes are always present in normal microflora, mucous membranes of the body, in the gastrointestinal tract and genitourinary system. They are classified as conditionally pathogenic microorganisms, since they are natural inhabitants of biotopes of a living organism.

With a decrease in immunity or the influence of negative factors, bacteria begin to actively multiply uncontrollably, and microorganisms turn into pathogens and become sources of infection. Their waste products are hazardous, toxic and quite corrosive substances. They are capable of easily penetrating cells or other organs of the body and affecting them.

In the body, some enzymes (for example, hyaluronidase or heparinase) increase the pathogenicity of anaerobes, as a result, the latter begin to destroy muscle fibers and connective tissue, which leads to a violation of microcirculation. Vessels become fragile, erythrocytes are destroyed. All this provokes the development of immunopathological inflammation of blood vessels - arteries, veins, capillaries and microthrombosis.

The danger of the disease is associated with a large percentage of deaths, so it is extremely important to notice the onset of the infection in time and immediately start treating it.

Causes of infection

There are several main reasons for infection:

• Creation of suitable conditions for the vital activity of pathogenic bacteria. This can happen:
• when an active internal microflora enters the sterile tissue;
• when using antibiotics that have no effect on anaerobic gram-negative bacteria;
• in case of circulatory disorders, for example, in the case of surgery, tumors, injuries, ingestion of a foreign body, vascular diseases, with tissue necrosis.
• Infection of tissue with aerobic bacteria. They, in turn, create the necessary conditions for the vital activity of anaerobic microorganisms.
• Chronic diseases.
• Some tumors that are localized in the intestine and head are often accompanied by this disease.

Types of anaerobic infections

It differs depending on which agents are provoked and in which area:

Surgical infection or gas gangrene

Anaerobic surgical infection or gas gangrene is a complex complex reaction of the body to the effects of specific pathogens. It is one of the most difficult and often untreatable wound complications. In this case, the patient is worried about the following symptoms:

• increasing pain with a feeling of fullness, since the process of gas formation occurs in the wound;
• fetid odor;
• exit from the wound of a purulent heterogeneous mass with gas bubbles or splashes of fat.

The edema of the tissues progresses very quickly. Outwardly, the wound becomes gray-green in color.

Anaerobic surgical infection is rare, and its occurrence is directly related to the violation of antiseptic and sanitary standards when performing surgical operations.

Anaerobic Clostridial Infections

The causative agents of these infections are obligate bacteria that live and reproduce in an oxygen-free environment - spore-forming representatives of Clostridium (gram-positive bacteria). Another name for these infections is clostridiosis.

In this case, the pathogen enters the human body from the external environment. For example, these are the following pathogens:

• tetanus;
• botulism;
• gas gangrene;
• toxic infections associated with the consumption of low-quality contaminated food.

The toxin secreted, for example, by clostridia, contributes to the appearance of exudate - a fluid that appears in body cavities or tissue during inflammation. As a result, the muscles swell, become pale, a lot of gas appears in them, and they die off.

Anaerobic non-clostridial infections

Unlike obligate bacteria, representatives of a facultative species are able to survive in the presence of an oxygen environment. The causative agents are:

• (globular bacteria);
• shigella;
• escherichia;
• yersinia.

These pathogens cause anaerobic non-clostridial infections. These are more often purulent-inflammatory infections of the endogenous type - otitis media, sepsis, abscesses of internal organs and others.

In gynecology

The microflora of the female genital tract is rich in various microorganisms and anaerobes as well. They are part of a complex microecological system that contributes to the normal functioning of a woman's genitals. Anaerobic microflora is directly related to the occurrence of severe pyoinflammatory gynecological diseases, for example, acute bartholinitis, acute salpingitis and pyosalpinx.

The penetration of anaerobic infection into the female body is facilitated by:

• trauma to the soft tissues of the vagina and perineum, for example, during childbirth, during abortion or instrumental examinations;
• various vaginitis, cervicitis, erosion of the cervix, tumors of the genital tract;
• remnants of membranes, placenta, blood clots after childbirth in the uterus.

An important role in the development of anaerobic infection in women is played by the presence, administration of corticosteroids, radiation and chemotherapy.

Qualification of anaerobic infections by localization of its focus

The following types of anaerobic infections are distinguished:

• Infection of soft tissues and skin... The disease is caused by anaerobic gram-negative bacteria. These are superficial diseases (cellulite, infected skin ulcers, consequences after major diseases - eczema, scabies and others), as well as subcutaneous infections or postoperative ones - subcutaneous abscesses, gas gangrene, bite wounds, burns, infected ulcers in diabetes, vascular diseases. With deep infection, soft tissue necrosis occurs, in which there is an accumulation of gas, gray pus with a foul odor.
• Bone infection... Septic arthritis is often a consequence of neglected Vincent, osteomyelitis, a purulent-necrotic disease that develops in the bone or bone marrow and surrounding tissues.
• Internal infections, including, women may experience bacterial vaginosis, septic abortion, abscesses in the genital apparatus, intrauterine and gynecological infections.
• Bloodstream infections - sepsis. It spreads through the bloodstream;
• Serous cavity infections - peritonitis, that is, inflammation of the peritoneum.
• Bacteremia- the presence of bacteria in the blood, which enter there exogenously or endogenously.

Aerobic Surgical Infection

Unlike anaerobic infections, aerobic pathogens cannot exist without oxygen. Cause infection:

• diplococci;
• sometimes;
• intestinal and typhoid bacilli.

The main types of aerobic surgical infection include:

• furuncle;
• furunculosis;
• carbuncle;
• hydradenitis;
• erysipelas.

Aerobic microbes enter the body through the affected skin and mucous membranes, as well as through the lymphatic and blood vessels. It is characterized by increased body temperature, localized redness, swelling, pain and redness.

Diagnostics

For a timely diagnosis, it is necessary to correctly assess the clinical picture and provide the necessary medical assistance as soon as possible. Depending on the localization of the focus of the infection, different specialists are engaged in diagnostics - surgeons of different directions, otolaryngologists, gynecologists, traumatology.

Only microbiological studies can confirm for sure the participation of anaerobic bacteria in the pathological process. However, a negative answer about the presence of anaerobes in the body does not reject their possible participation in the pathological process. According to experts, about 50% of the anaerobic representatives of the microbiological world today are uncultivated.

High-precision methods for indicating anaerobic infection include gas-liquid chromatography and mass spectrometric analysis, which determines the amount of volatile liquid acids and metabolites - substances that form during metabolism. No less promising methods are the determination of bacteria or their antibodies in the patient's blood using enzyme immunoassay.

They also use express diagnostics. The biomaterial is studied in ultraviolet light. Carry out:

• bacteriological sowing of the contents of the abscess or the separated part of the wound into the nutrient medium;
• sowing blood for the presence of bacteria, both anaerobic and aerobic species;
• blood sampling for biochemical analysis.

The presence of an infection is indicated by an increase in the amount of substances in the blood - bilirubin, urea, creatinine, as well as a decrease in the content of peptides. Increased activity of enzymes - transaminase and alkaline phosphatase.

X-ray examination reveals the accumulation of gases in the damaged tissue or body cavity.

When diagnosing, it is necessary to exclude the presence in the patient's body of erysipelas - skin infectious disease, deep vein thrombosis, purulent-necrotic tissue lesions by another infection, pneumothorax, exudative erythema, frostbite stage 2-4.

Treatment of anaerobic infection

When treating, you can not do such measures as:

Surgical intervention

The wound is dissected, the dead tissue drastically dry out, and the wound is treated with a solution of potassium permanganate, chlorhexidine or hydrogen peroxide. The procedure is usually performed under general anesthesia... With extensive tissue necrosis, limb amputation may be required.

Drug therapy

It includes:

• taking anesthetic components, vitamins and anticoagulants - substances that prevent clogging of blood vessels by blood clots;
• antibiotic therapy - taking antibiotics, and the appointment of one or another drug occurs after an analysis has been made for the sensitivity of pathogens to antibiotics;
• administration of anti-gangrenous serum to the patient;
• transfusion of plasma or immunoglobulin;
• introduction of drugs that remove toxins from the body and eliminate their negative effects on the body, that is, they detoxify the body.

Physiotherapy

In physiotherapy, wounds are treated with ultrasound or laser. Ozone therapy or hyperbaric oxygenation is prescribed, that is, they act with oxygen under high pressure on the body for medicinal purposes.

Prevention

To reduce the risk of developing the disease, a high-quality primary wound treatment is carried out on time, a foreign body is removed from the soft tissues. When carrying out surgical operations, the rules of asepsis and antiseptics are strictly observed. For large areas of damage, antimicrobial prophylaxis and specific immunization - preventive vaccinations are carried out.

What will be the result of the treatment? This largely depends on the type of pathogen, the location of the focus of infection, timely diagnosis and properly selected treatment. Doctors usually give a cautious but favorable prognosis for such diseases. With advanced stages of the disease, with a high degree of probability, we can talk about the death of the patient.

Next article.

Traditionally, the term "Anaerobic infection" referred only to infections caused by Clostridia. However, in modern conditions, the latter are involved in infectious processes not so often, only in 5-12% of cases. The main role is assigned to non-spore-forming anaerobes. Both types of pathogens are united by the fact that the pathological effect on tissues and organs is carried out by them under conditions of general or local hypoxia using the anaerobic metabolic pathway.

Anaerobic infection occupies a special place in connection with the exceptional severity of the course of the disease, high mortality (14-80%), frequent cases of deep disability of patients.

By and large, anaerobic infections include infections caused by obligate anaerobes, which develop and exert their pathogenic effect under conditions of anoxia (strict anaerobes) or at low oxygen concentrations (microaerophiles). However, there is large group the so-called facultative anaerobes (streptococci, staphylococci, proteus, Escherichia coli, etc.), which, falling into hypoxic conditions, switch from aerobic to anaerobic metabolic pathways and are capable of causing the development of an infectious process clinically and pathomorphologically similar to a typical anaerobic.

Anaerobes are ubiquitous. In the human gastrointestinal tract, which is their main habitat, more than 400 species of anaerobic bacteria have been isolated. The natural habitat of Clostridia is the soil and large intestine of humans and animals.

Anaerobic endogenous infection develops in the event of the appearance of opportunistic anaerobes in places unusual for their habitat. The penetration of anaerobes into tissues and the bloodstream occurs during surgical interventions, with injuries, invasive manipulations, the decay of tumors, with translocation of bacteria from the intestine in acute diseases of the abdominal cavity and sepsis.

However, for the development of infection, it is not enough just for bacteria to get into unnatural places of their existence. For the introduction of anaerobic flora and the development of an infectious pathological process, the participation of additional factors is necessary, which include large blood loss, local tissue ischemia, shock, starvation, stress, overwork, etc. Concomitant diseases play an important role ( diabetes, collagenoses, malignant tumors, etc.), long-term intake of hormones and cytostatics, primary and secondary immunodeficiency against the background of HIV infection and other chronic infectious and autoimmune diseases.

For all anaerobic infections, regardless of the localization of the focus, there are a number of very characteristic clinical signs):

• erasure of local classic signs of infection with a predominance of symptoms of general intoxication;
• localization of the focus of infection in the habitats of anaerobes;
• unpleasant putrefactive smell of exudate, which is a consequence of anaerobic oxidation of proteins;
• the predominance of processes of alterative inflammation over exudative with the development of tissue necrosis;
• gas formation with the development of emphysema and crepitus of soft tissues due to the formation of products of anaerobic metabolism of bacteria (hydrogen, nitrogen, methane, etc.), poorly soluble in water.

Various types of anaerobes can cause both superficial and deep purulent-necrotic processes with the development of serous and necrotic cellulitis, fasciitis, myositis and myonecrosis, combined lesions of several structures of soft tissues and bones.

Most anaerobic infections have a violent onset. Symptoms of severe endotoxicosis (high fever, chills, tachycardia, tachypnea (rapid breathing), lack of appetite, lethargy, etc.) usually come to the fore, which are often 1-2 days ahead of the development of local symptoms of the disease. At the same time, part of the classic symptoms of purulent inflammation (edema, hyperemia, soreness, etc.) falls out or remains hidden, which complicates the timely prehospital, and sometimes intrahospital, diagnosis of anaerobic phlegmon and delays the onset surgical treatment... It is characteristic that often the patients themselves do not associate their "malaise" with the local inflammatory process until a certain time.

In the treatment of anaerobic infections, surgical intervention and complex intensive therapy are of primary importance. Surgical treatment is based on radical HOGO with subsequent repeated treatment of an extensive wound and its closure using available plastic methods.

The time factor in the organization of surgical care is important, sometimes decisive. Delaying the operation leads to the spread of infection over large areas, worsening the patient's condition and increasing the risk of the intervention itself. In patients with septic shock surgical intervention is possible only after stabilization of arterial pressure and resolution of oligoanuria (manifestations of acute renal failure).

Clinical practice has shown that it is necessary to abandon the so-called "stripe" incisions, widely accepted several decades ago and not forgotten by some surgeons, without performing necrectomy. This tactic leads to the death of patients in almost 100% of cases.

During the surgical treatment, it is necessary to perform a wide dissection of the tissues affected by the infection, with the incisions coming up to the level of visually unchanged areas. The spread of anaerobic infection is characterized by pronounced aggressiveness, overcoming various obstacles in the form of fascia, aponeuroses and other structures, which is not typical for infections that occur without the dominant participation of anaerobes.

With HOGO, it is necessary to remove all nonviable tissue, regardless of the extent of the lesion.After radical HOHO, the edges and bottom of the wound should be visually unchanged tissue. The area of \u200b\u200bthe wound after surgery can occupy from 5 to 40% of the body surface. Do not be afraid of the formation of very large wound surfaces, since only complete necrectomy is the only way to save the patient's life. Palliative surgical treatment inevitably leads to the progression of phlegmon, systemic inflammatory response syndrome, the development of sepsis and a deterioration in the prognosis of the disease.

The Department of Purulent Surgery at GKB29 has accumulated global experience in the treatment of this nosology. Timeliness of the diagnosis, adequate volume of surgical intervention are the basis for a favorable outcome in the supervision of patients with anaerobic infection. Considering the severity of the patient's condition, specialists from the intensive care unit provide tremendous assistance in treatment. Availability of modern antibacterial drugs, dressing equipment, qualified middle and young medical personnel, as well as a competent attending physician, as the head of the treatment process - create conditions for a comprehensive adequate fight against this formidable disease. Also, the department performs the whole range of reconstructive plastic operations after stopping the purulent process.

Anaerobic infection

Treatment both Clostridial and non-Clostridial anaerobic wounds are operative: a wide lesion and necrotic tissue. Decompression of edematous, deeply located tissues is facilitated by the wide. Rehabilitation of the focus is carried out as radically as possible, combining it with treatment with antiseptics and drainage. In the immediate postoperative period, the wound is left open, it is treated with osmotically active solutions and ointments. If necessary, re-remove areas of necrosis. If a wound infection develops against the background of a fracture of the bones of the limb, then plaster cast may be the preferred method of immobilization. In a number of cases, already during the initial revision of the limb wound, such extensive tissues are revealed that it becomes the only method of surgical treatment. It is carried out within healthy tissues, but sutures are applied to the wound of the stump no earlier than 1-3 days after the operation, controlling the likelihood of recurrence of the infection during this period.

The main tasks of infusion therapy A. and. maintenance of optimal hemodynamic parameters, elimination of microcirculation and metabolic disorders, achievement of a substitutional and stimulating result. Special attention is paid to detoxification using drugs such as hemodesis, neohemodesis, etc., as well as various extracorporeal sorption methods - hemosorption, plasma sorption, etc.

PreventionA. and. effective under the condition of adequate and timely surgical treatment of wounds, careful adherence to asepsis and with planned surgical interventions, preventive use of antibiotics, especially in severe injuries and gunshot wounds... In cases of extensive damage or severe contamination of wounds, for a preventive purpose, a polyvalent antigangrenous serum is administered at an average prophylactic dose of 30,000 IU.

The sanitary and hygienic regime in the ward where the patient with clostridial wound infection is staying should exclude the possibility of contact spread of infectious agents. To this end, it is necessary to adhere to the relevant requirements for the disinfection of medical instruments and equipment, premises and, toiletries, dressings, etc. (see Disinfection) .

Anaerobic non-clostridial infection does not tend to spread intra-hospital, therefore, the sanitary and hygienic regime for patients with this pathology must comply with the general requirements adopted in the department of purulent infection.

Bibliography: Arapov D.A. Anaerobic gas infection, M., 1972, bibliogr .; A.P. Kolesov, A.V. Stolbovoy and Kocherovets V.I. in surgery, L., 1989; Kuzin M.I. and others. Anaerobic non-clostridial infection in surgery, M., 1987; high oxygen pressure,. from English, ed. L.L. Shika and T.A. Sultanov, s. 115, M., 1968

Figure: 5a). A patient with non-clostridial anaerobic infection of odontogenic origin. Lesion in the area of \u200b\u200bthe right orbit before treatment.

Figure: 3. X-ray of the lower leg with an open fracture of the bones, complicated by Clostridial infection: visible accumulations of gas, fragmenting the muscles of the lower leg.

leather coloring "\u003e

Figure: 2. Clostridial infection of the femoral stump with an inadequate level of limb amputation due to ischemic gangrene: a characteristic spotted-marble skin color.

1. Small Medical Encyclopedia. - M .: Medical encyclopedia... 1991-96 2. First aid. - M .: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M .: Soviet encyclopedia... - 1982-1984.

• Anashism

See what "Anaerobic infection" is in other dictionaries:

See Gas Gangrene ... Big Encyclopedic Dictionary

Anaerobic infection is one of the most severe infections, which leads to the development of severe endogenous intoxication with damage to vital important organs and systems and retains a high mortality rate. Anaerobes are divided into 2 ... ... Wikipedia

See Gas gangrene. * * * ANAEROBIC INFECTION ANAEROBIC INFECTION, see Gas gangrene (see GAS GANGRENA) ... encyclopedic Dictionary

ANAEROBIC INFECTION - (wound) - an infectious process caused by anaerobes. It is characterized by a rapidly emerging and progressive tissue necrosis with the formation of gases in them and the absence of pronounced inflammation, severe intoxication. There are two groups ... ... Encyclopedic Dictionary of Psychology and Pedagogy

The content of the article

This type of wound infection belongs to the most serious complications of combat trauma - wounds, frostbites, burns, etc. In the literature, it is described under various names: "gas gangrene", "anaerobic gangrene", "gas phlegmon", etc.
In different periods of the First World War, anaerobic infection occurred in 2-15% of the wounded. During the Great Patriotic War, according to various authors, it arose in approximately 0.5-2% of the wounded (A. N. Berkutov, 1965; A. A. Vishnevsky and M. I. Shreiber, 1975, etc.).

Etiology and pathogenesis of anaerobic infection

Anaerobic infection wounds are caused by microbes from the genus Clostridium: CI. perfringens, C.I. septicum, C.I. oedematiens, C.I. histolyticum. The causative agents of anaerobic infection are characterized by the following features.
CI. perfringens - the most common causative agent of gas infection in humans. The microbe is very common in nature. It is found in large quantities in the intestines of humans, animals and in the earth. The microbe is immobile, forms spores and a toxin consisting of hemolysin, myotoxin and neurotoxin. The effect of this toxin on living tissues leads to the formation of bloody exudate and gas, swelling and necrosis of tissues, especially muscles. Muscles under the influence of the toxin become pale, "the color of cooked meat", contain many gas bubbles. Large doses of the toxin are fatal.
CI. oedematiens - a mobile spore-bearing microbe containing hemolysin and exotoxin. The toxins of this microbe are characterized by high activity and the ability to quickly form edema of the subcutaneous, intermuscular tissue and muscles. The toxin also has a permanent and specific hemolytic effect. When boiled, spores die only after 60 minutes (E.V. Glotova, 1935).
CI. septicum - a mobile spore-bearing microbe discovered by Pasteur in 1861. Its toxin is hemolytic, causing rapidly spreading bloody-serous edema, serous-hemorrhagic impregnation of subcutaneous tissue, muscle tissue, in more rare cases - muscle death. The toxin entering the bloodstream leads to a rapid drop in blood pressure, vascular paralysis and damage to the heart muscle. The microbe is found in the soil, intestines of humans and animals. Spores withstand boiling for 8 to 20 minutes.
CI. histolyticum - spore-bearing, mobile microbe. Discovered in 1916. The toxin of this microbe contains the progeolytic enzyme fibrolysin, under the action of which there is a rapid melting of muscles, subcutaneous tissue, connective tissue and skin. The melted tissue turns into an amorphous mass that resembles raspberry jelly. There is no gassing.
Toxins of causative agents of gas infection are complexes of various enzymes of protein origin (leticinase, hyaluronidase, deoxyribonuclease, hemolysin, etc.). These enzymes, as well as the products of their cleavage of tissues, are absorbed into the blood, have a general toxic effect on the body as a whole and contribute to the spread (development) of microbes.
The main sources of contamination of wounds with anaerobic pathogens are soil and clothing contaminated with it. In crops from fresh wounds CI. perfringens occurs in 60-80%; CI. oedematiens - in 37-64%;
CI. septicum - 10-20%; CI. histolyticum - in 1-9% (A.V. Smolyannikov, 1960). Along with the listed microbes, other types of anaerobic and aerobic microorganisms (CI.sporogenes, CI.terticum, CI.oerofoctidus, anaerobic and aerobic streptococci, staphylococcus, E.coli, Proteus, etc.) are found in a fresh gunshot wound. Aerobic microorganisms developing in the wound, especially streptococci and staphylococci, can be activators of anaerobes of the "group of four", increasing their reproduction, pathogenicity, hemolytic and necrotic properties. Consequently, the flora of the gas infection is usually polymicrobial. However, the leading role in this disease belongs to anaerobic microbes.
Despite the high frequency of contamination of gunshot wounds anaerobic microorganisms, anaerobic infection develops in them relatively rarely (0.5-2%), with a combination of certain local and general factors. Local factors include, first of all, extensive tissue damage, which is most often observed with shrapnel wounds, especially with bone damage.
The experience of the Great Patriotic War has confirmed that in case of gunshot fractures of the extremities, accompanied, as a rule, by significant damage to soft tissues, anaerobic infection occurs 3.5 times more often than with injuries of the extremities without damage to the bone. The type of injury also affects the frequency of development of anaerobic infection: with shrapnel wounds, complications of anaerobic infection were observed 1.5 times more often than with bullet wounds, and with blind wounds - twice more often than with through (O.P. Levin, 1951) ...
The localization of wounds plays an important role in the occurrence of anaerobic infection.
In most cases (75%), the anaerobic process developed with injuries of the lower extremity, this is apparently explained by the presence of large muscle masses, enclosed in dense aponeurotic cases. The traumatic edema that develops after injury leads to compression of the muscles and blood vessels feeding them in the aponeurotic cases and the development of muscle tissue ischemia, which, as you know, favors the development of anaerobic infection. It is possible that the fact that lower limbs more easily contaminated.
Factors predisposing to the development of anaerobic infection are: local circulatory disorders due to damage to the great vessels, the use of a tourniquet, tight wound tamponade, compression of tissues by hematoma, shock and blood loss, etc.
Meteorological conditions and seasonality have a definite influence on the incidence of anaerobic infection. It has been reliably established that the incidence of anaerobic complications of wounds increases during rainy weather, more often in spring and autumn, as well as with significant soil contamination with manure and feces at the site of hostilities.
These facts can be explained by the fact that in spring and autumn, hostilities are often conducted on soggy soil and there is massive contamination of clothing and wounds with soil.
A general weakening of the body caused by fatigue, cooling, and malnutrition contributes to the development of anaerobic infection.
Anaerobic infection becomes more frequent with the late removal of victims from the battlefield (from the focus), with an unsatisfactory and belated first medical care and the first medical care, when evacuating the wounded on bad roads and in vehicles not adapted for evacuation. During evacuation in case of limb fractures, the quality of transport immobilization is of paramount importance.
However, the main role in the development of anaerobic infection is played by late and technically imperfect primary surgical debridement of the wound or the refusal of this operation if indicated.
The risk of anaerobic infection increases if, after initial surgical treatment, the wound is sutured tightly.

Clinic of anaerobic infection

The most dangerous period for the development of anaerobic infection is 6 days after injury. It is during this period that most often in the wound are created favorable conditions for the development and life of pathogenic anaerobes. In classic cases incubation period with this complication, it is short - about 24 hours, therefore, early recognition of this complication is necessary. Late diagnosis, as a rule, leads to an unfavorable outcome, due to the peculiarities of the course of anaerobic infection: its clinical manifestations develop rapidly, at an increasing pace, which is not observed in other types of wound infection.
Sometimes the course of anaerobic infection takes on a fulminant character. Tissue necrosis, edema develop in the eyes. Proteolysis of muscles and erythrocytes leads to the formation of gases in the tissues - hydrogen, hydrogen sulfide, ammonia, carbonic acid, hemorrhagic exudate appears in the subcutaneous tissue, hemolytic spots on the skin, etc. Rapid reproduction of anaerobes in the wound, a large amount of bacterial tissue toxins cause severe intoxication of the body. Its main features are early onset, rapid progression, and increasing severity.
Anaerobic infection is characterized by a variety and dynamics of clinical manifestations. With the growth of pathological processes, the symptomatology of anaerobic infection also changes, but from a practical point of view, early symptoms are most important.
1. Sharp, unbearable pain that does not respond to pain relievers. After injury, the pain has a certain dynamics. The initial pain associated with the wound subsides.
A dormant period begins (the period of incubation of the anaerobic flora). With the development of anaerobic infection, the pain increases dramatically and quickly becomes unbearable. With the formation of a large array of soft tissue necrosis and increased intoxication, the pain again decreases or disappears. In a state of severe toxicoinfection, the wounded do not complain of anything at all (late stage).
2. Rapidly progressive edema of the tissues of the limb. It causes complaints of a feeling of fullness or distention of the limb. To determine the rate of increase in edema A. V. Melnikov (1938) proposed to impose a ligature around the limb 8-10 cm above the wound ("ligature symptom"). The symptom is considered positive if the ligature, tightly applied above the wound, begins to cut. According to A. V. Melnikov (1945), if the ligature is cut to a depth of 1-2 mm in 2-3 hours after application, amputation is necessary.
If two of these symptoms appear, you should immediately remove the bandage from the wound and carefully examine it and the entire injured limb.
3. Changes in the wound. Dryness, a small amount of wound discharge - bloody ("lacquer blood"). The muscles are gray in color, resembling boiled meat in appearance. As a result of the developing edema and tissue impregnation with gas, muscle tissue prolapses from the wound opening, muscle fibers do not contract or bleed, and are easily torn. With late diagnosis of anaerobic infection, the dead muscles are dark gray in color. Often, characteristic blisters are formed on the skin of the affected segment, filled with either bloody, or transparent, or cloudy liquid. The skin becomes “bronze”, “saffron”, brown or blue in color. This is due to diapedesis of erythrocytes, which are rapidly destroyed by the action of enzymes secreted by microorganisms; hemoglobin breaks down to form a dirty brown pigment, which gives the tissues a specific color.
Often, wounds with developed anaerobic infection emit an unpleasant, putrid smell, reminiscent of the smell of mice, "rotten hay" or "sauerkraut".
4. Gas in the soft tissues of the affected segment is a reliable symptom of the development of anaerobic infection. Gas formation, as a rule, occurs after the development of edema and indicates tissue destruction as a result of the vital activity of anaerobic microbes, primarily CI. perfringens. The presence of gas is determined percussion: a tympanic sound is detected in the area of \u200b\u200bgas propagation. In the subcutaneous tissue, the presence of gas can be established by palpation - by the "crunch of dry snow" (a symptom of crepitus of gas bubbles). When shaving hair, a slight crackling sound is felt on the skin surrounding the wound - a resonance over the area of \u200b\u200btissue soaked in gas ("razor symptom"). Beating with tweezers gives a characteristic boxed sound.
French surgeon Lemaître recommends clicking the wound circumference for diagnostic purposes - a characteristic resonating sound is obtained.
5. Lack of sensitivity and motor function in the distal parts of the limb is an early and formidable symptom of the development of anaerobic infection. These disorders appear even with outwardly small changes on the part of the wound and limb and are very important: they help to identify an anaerobic infection when, at first glance, there are no other symptoms yet. Therefore, doctors in the admission and triage departments should always have a pin to determine the sensitivity of the distal extremities and fingers.
6. X-ray examinations - an auxiliary method for the determination of gas in tissues. When gas spreads through muscle tissue, "cirrus clouds" or "herringbones" are noted on the roentgenogram, and in the presence of gas in the subcutaneous tissue, the image resembles a "honeycomb", sometimes on the roentgenogram, individual gas bubbles or strips of gas are visible, spreading through the intermuscular spaces. Toxins of anaerobic infection affect many organs and all systems of the wounded. In this case, a number of general symptoms develop.
7. The temperature is most often in the range of 38-38.9 °.8. The pulse rate of a quarter of the wounded does not exceed 100 beats per minute, in almost 70% more than 120 beats per minute (OA Levin, 1951). A terrible symptom is the discrepancy between the pulse and temperature, the so-called "scissors": the pulse rate rises, and the temperature curve goes down.
9. Blood pressure with an increase in anaerobic infection progressively decreases.
10. Changes in the blood: high neutrophilic leukocytosis, shift of the formula to the left, lymphopenia, eosinopenia.
11. Icterus sclera due to hemolysis of erythrocytes.
12. The condition of the gastrointestinal tract - the tongue is dry, coated (36% of the wounded have a wet tongue). The injured experience a feeling of unquenchable thirst and dry mouth - a possible complication wound process anaerobic infection. The appearance of nausea and vomiting undoubtedly indicates a great intoxication of the body.
13. Facial expression. Anaerobic infection leads to a change in the appearance of the wounded. The skin of the face becomes pale, in an earthy shade, the features of the face become sharper, the eyes sink. There is a characteristic appearance and facial expression of the wounded - "fades Hippocratica" .14. Neuropsychiatric state ranges from mild euphoria to sharp excitement, from a state of indifference, lethargy to severe depression. Often there is an incorrect orientation and assessment of one's own feelings and state. However, consciousness persists until death.

Depending on the characteristics of the clinical course, the following forms of anaerobic infection are distinguished:
1) lightning-fast - a few hours after injury;
2) rapidly progressing - 1-2 days after injury;
3) slowly progressing - with a long incubation period.
Depending on the nature of the pathological process, anaerobic infection is divided into the following forms:
1) with a predominance of gas - gaseous form;
2) with a predominance of edema - malignant edema;
3) mixed forms.
Depending on the depth of tissue damage, there are:
1) deep - subfascial
2) superficial - epifascial forms.
It should be remembered that anaerobic infection does not always occur from the very beginning with an extremely serious general condition of the patient. The absolutization of such ideas can be the reason for the late diagnosis. Only a careful observation of the wounded will make it possible to recognize in a timely manner, against a generally favorable background, perhaps the only symptom characteristic of an anaerobic infection. For example, a change in the wound and surrounding skin - muscle swelling, swelling, tissue tension, soreness along the large nerves and vessels, pale skin, the appearance of hemorrhagic spots, etc. In other cases, it may be the appearance of pain in the wound, complaints about squeezing a limb with a bandage, the appearance of anxiety or thirst, fever.
Knowledge of the clinic of anaerobic infection in all its manifestations, a careful examination of each wounded person are a guarantee of early detection of anaerobic infection.
Gunshot wounds with a lot of crushed and dead tissue can be the basis for the development of a putrefactive infection. Due to the fact that some manifestations of putrefactive infection are similar to those observed in gas gangrene, it is necessary to know the general and features these two types of wound infection.
The causative agents of putrefactive infection are B. coli, B. ruosuanes, B. putrificum, Streptococus fecalis, B. proteus vulgaris. B. eraphysematicus, Escherichia coli and many other anaerobic and aerobic microorganisms. The vital activity of these microbes causes putrefactive decay of dead and non-viable tissues. This is accompanied by the processes of putrefactive fermentation, the release of hemorrhagic exudate and a large amount of fetid gas. The absorption of protein breakdown products causes intoxication, fever, chills, and the presence of gas in the tissues suggests an anaerobic infection. Differential diagnosis with anaerobic infection: with putrefactive infection, the general condition of the wounded does not suffer as much as with anaerobic infection. In particular, despite high temperature, leukocytosis and changes in the leukocyte blood count, general form the wounded person leaves a favorable impression: the face is not sunken, the skin does not differ in pallor, the look is lively and calm. The pulse, although quickened, is of satisfactory filling and tension, and, most importantly, corresponds to the temperature reaction. The wounded's tongue is moist, may be slightly coated. There is no feeling of thirst, nausea and vomiting. In other words, pronounced intoxication is not inherent in an isolated, pure form of putrefactive infection.
Local changes in the wound, as well as on the part of the limb as a whole, with a putrid infection have their own characteristics. For wounds with putrefactive decay, a sharp, bad, sugary-sweet odor is characteristic. A brownish, offensive pus is found in the wound. The edges of the wound are swollen, hyperemic, painful. There are always areas of dead tissue in the wound, the cellulose is saturated with serous-purulent exudate with gas bubbles (a symptom of crepitus), and at the same time healthy, well-supplied muscles are always preserved on the cut. Although the limb edema is pronounced, it grows slowly, not malignant. There are no sensory disturbances in the distal parts of the limb.

Prevention of anaerobic infection

Timely and sufficient in terms of volume, the operation has a striking effect, and the further course of the wound process becomes favorable.
Prevention of wound infection consists of a set of measures. In the military area, it begins with simple but extremely important first aid measures on the battlefield, which include the timely search for the wounded, the imposition of an aseptic dressing on the wound, the quick and correct application of a tourniquet in order to stop bleeding, transport immobilization of the limbs in case of fractures, the introduction of anesthetic from a syringe-tube, giving tableted antibiotics, careful removal and sparing evacuation of the wounded.
In the subsequent stages of medical evacuation preventive actions expand, supplemented (including parenteral administration of antibiotics) and end with primary surgical treatment of the wound, which is the main means of preventing anaerobic infection.
Prophylactic use of anti-gangrenous sera ( passive immunization) in the Great Patriotic War did not meet expectations. There is currently no convincing evidence of its effectiveness. Therefore, antigangrenous serum is not currently used as a prophylactic agent for anaerobic infection.

Treatment of anaerobic infection

The treatment of wounded with anaerobic infection is carried out in the OmedB (OMO), in the HMC and in the SVPHG for wounded in the hip and large joints. It consists of a set of measures, the basis of this complex is an urgent surgical intervention. Given the contagious nature of anaerobic infection, the wounded with this disease should be isolated and concentrated in a tent or compartment deployed for this shoal.
In OMedB (OMO) anaerobic is usually deployed in the UST-56 tent. In the anaerobic one, not only the placement and inpatient treatment of the wounded is provided, but also surgical interventions: wide incisions, amputations, disarticulation of the limbs. In this regard, the tent is divided into two halves with the help of a curtain made of sheets, one of which is a dressing room (operating room), and the other is a hospital for three to four beds. The equipment and equipment of this tent must provide the necessary assistance to these wounded: an operating table, a table for sterile instruments, instrument tables, a table for sterile solutions, dressings and medicines, a basin stand, enameled and galvanized basins, care items, a washbasin, a stand for stretcher, bottle holder. On the table for medicines, in addition to the usual means, there should be a sufficient amount of solutions of potassium hypermanganate, hydrogen peroxide, hypertopic sodium chloride solution, polyvalent serum. The instrumentation is selected so that it is possible to make wide incisions and excisions, the imposition of counterpertures, amputations and disarticulation.
In military field surgical hospitals for wounded in the limb, special anaerobic departments are created: wards for accommodating patients with anaerobic infection and an operating and dressing room with all the necessary equipment, instruments and materials. The attendants and doctors are obliged to strictly observe the anti-epidemic regime and the rules of personal hygiene (thorough washing of hands, change of gowns after each dressing or operation). Surgical interventions and dressings must be carried out with surgical gloves. Contaminated linen, blankets and dressing gowns are soaked in a 2% soda solution and boiled for an hour in the same solution, and then washed. Used dressing material, drains, wooden tires are burned, metal tires are burned on fire. Surgical gloves used during operations and dressings are mechanically cleaned (washed in warm water and soap) and then sterilized in an autoclave. The instruments used in operations and dressings, after mechanical cleaning, are sterilized for an hour in a 2% soda solution. A dressing table, underlay oilcloths, coasters, etc. are treated with solutions (2-3%) of carbolic acid, 1-3% lysol solution, etc.
Surgical intervention for anaerobic infection is performed urgently at the first signs of an anaerobic process. It should take as little time as possible and be as radical as possible.
Depending on the location, nature and spread of the anaerobic infection, 3 types of operations are used:
1) wide "stripe" cuts on the damaged segment of the limb;
2) incisions combined with excision of the affected tissues;
3) amputation (disarticulation).
Before surgery, the wounded need a short (30-40 minutes) preoperative preparation: the use of heart drugs, blood transfusion, polyglucin, intravenous glucose. Drip transfusions of blood or polyglucin should be performed during the operation. These measures increase the vascular tone and prevent the operational shock to which the wounded with anaerobic infection are exposed. Preoperative preparation - perirenal or vagosympathetic blockade (on the side of the lesion) and intravenous administration of sodium salt, penicillin - 1,000,000 U and ristomycin - 1,000,000 U (A.V. Vishnevsky and M.I. Shreiber, 1975).
In anaerobic infection surgery, the choice of pain relief is very important.
Guided gas anesthesia with nitrous oxide with oxygen is less dangerous for anaerobic infection than other types of anesthesia, according to American surgeons, who have developed in the treatment of victims of the Korean and Vietnam wars (Fisher, 1968).
General principles of the surgical technique of tissue excision in anaerobic infection. The wound is widely dissected and opened with hooks. Then, in the longitudinal direction with a Z-shaped incision, the aponeurotic cases are opened, in which muscle tissue is usually squeezed due to the accumulation of gas and edematous fluid during a deep anaerobic process. After that, necrotic muscles are widely excised within the visually unaffected tissues along the entire course of the wound channel - from the inlet to the outlet. Foreign bodies and free-lying bone fragments are removed, all blind pockets and depressions that go away from the wound channel are opened. The wound should be wide-gaping, boat-shaped. Suturing is contraindicated. The wound is left wide open. The tissue around the wound is infiltrated with antibiotics (penicillin, streptomycin). Irrigation tubes are inserted into the wound for the subsequent administration of antibiotics and loosely tamponed with gauze moistened with a solution of potassium permanganate or a solution of hydrogen peroxide.
After the operation, the limb should be well immobilized with plaster splints or plaster splints - until the acute symptoms subside, after which, according to indications, a deaf plaster cast can be applied.
Indications for limb amputation in anaerobic infection:
fulminant forms of anaerobic infection;
gangrene of the limb;
extensive lesions of the pathological process of the muscle mass of the limb, in which it is impossible to perform an exhaustive surgical intervention;
an advanced anaerobic infection, when the process spreads from the hip (shoulder) to the trunk;
extensive destruction of the limb, complicated by the anaerobic process;
the spread of the pathological process with the manifestations of severe toxemia and the rapid development of gas phlegmon;
intra-articular fractures of the thigh or lower leg, complicated by gas phlegmon or persecution;
gunshot wounds of the hip or shoulder joints, complicated by gas gangrene;
common forms of anaerobic infection originating from multi-splintered, especially intra-articular gunshot fractures, complicated by damage to the great vessels;
continuation of the anaerobic process after tissue dissection;
the course of anaerobic infection against the background of radiation sickness or other combined lesions.
The level of amputation in anaerobic infection is of great importance for outcomes: the cut-off line should be above the focus of infection - within healthy tissues. “It must be remembered that amputation through tissues affected by anaerobic infection not only causes shock, but always intensifies intoxication, from which the wounded die. Sometimes shock and intoxication are so significant that the wounded dies on the operating table or shortly after the operation ”(A. V. Melnikov, 1961).
Determining the level of amputation, proceed from the state of muscle tissue: gray, flabby, non-bleeding and non-contracting muscles enter the zone, the cut line is located higher.
However, when the focus of infection (wound) is localized in the upper third of the thigh or shoulder, truncation of the limb is always performed through the tissues affected by the anaerobic process. In these cases, it is necessary to dissect the stump with 2-3 longitudinal deep cuts and widely dissect the tissues affected by anaerobic infection.
Amputation should be performed without tourniquet, in a circular or patchwork manner. Sutures are not applied to the stump. Secondary sutures for closing the amputation stump are permissible only when the anaerobic infection is completely stopped. The stumps are covered with wet tampons dipped in a solution of furacilin (1: 5000) or hydrogen peroxide. The cut out fascial skin flap is placed over the tampons. The stump is immobilized with a plaster U-shaped splint.
Along with the surgical treatment of anaerobic infection, antitoxic antigangrenous serum must be used to neutralize (bind) specific toxins entering the bloodstream. Therapeutic dose of serum 150 ME. It can be administered intramuscularly and intravenously in the form of a multivalent mixture of 50 000 IU of antiperfringens, antiedematiens and antiseptic serums.
Serum for intravenous administration is diluted 5-10 times in warm isotonic sodium chloride solution and, after preliminary desensitization according to Bezredka, is poured by drip method.
Simultaneously with intravenous administration, antitoxic serum is injected intramuscularly to create a depot (V.N. Struchkov, 1957; D.A.Arapov, 1972; A.N. Berkutov, 1972, etc.). With any method of serum administration, careful monitoring of patients is necessary. When decreasing blood pressure, the appearance of anxiety, chills or the appearance of a rash, which indicates anaphylactic shock, the administration of serum is stopped and ephedrine, calcium chloride, concentrated glucose solution, and transfusion of one-group blood are used.
IN postoperative period patients with anaerobic infection need antibiotics.