EXPERIENCE IN THE USE OF BACTERIOPHAGES IN THE COMPLEX TREATMENT OF WOUND INFECTION

Summary. Infection in general, and surgical (wound) infection in particular, is one of the most complex and most urgent problems of our time. At the beginning of the antibiotic era, it seemed that the open class of antimicrobial drugs would finally solve this problem. But, after 20-30 years, it turned out that microbes have a very advanced system of protection against antibiotics. The problem of antibiotic resistance, in particular polyantibiotic resistance, arose. Increasing single and daily doses of antibiotics, the development of new antibiotics did not solve the problem. However, the increasingly widespread introduction of phage therapy threatens the emergence of the problem of resistance to bacteriophages. The aim is to analyze one's own experience of using phage therapy and formulate approaches to preventing bacteriophage resistance and minimizing its consequences/ Materials and methods. 14 patients with purulent and necrotic forms of wound infection, who had large defects of the skin and deeper tissues, were examined. In connection with the formation of polyantibiotic-resistant flora, phage therapy was started in these patients. Results and their discussion. The patients were hospitalized for a long time and received various antibiotics. As a result, the selection and formation of polyantibiotic-resistant strains took place. At the beginning of treatment, the seeding level (lg CFU/cm2) of the wound surface in patients of both groups was identical: (9.2 ± 0.2) and (9.1 ± 0.2). During 10 days, the seeding level decreased: in the main group — (4.9±0.3), in the control group — (6.8±0.3). A decrease in the seeding level below the “critical” level in the control group only in two patients (18.1%), in the main group in 10 (78.9%) patients (p<0.05). The course of the wound process in patients in the main group was more favorable: granulations appeared one and a half days earlier, and the wound was cleaned of dead tissues, pus and fibrin almost two days earlier. An average of 2.3 days passed between the appearance of granulations and wound cleansing in patients of the main group. Among patients in the control group, the “transitional” period lasted almost 3 days, which is 30% longer. Conclusion. The use of polyvalent bacteriophages is an effective method of treating wound infection. To prevent the development of resistance to bacteriophages, their clinical use should be clearly regulated and controlled. Its use should be limited to cases of severe wound infection. In the absence of an obvious clinical and bacteriological effect, the use of bacteriophage should be stopped and switched to other methods of treatment (active mechanical and physical antiseptics)