The influence of bacteriological monitoring on the choice of treatment strategy in minimally invasive surgical management of patients with intra-abdominal abscesses

Objective. To study the effect of changes in pathogenic microflora as a factor reflecting the effectiveness of treatment of patients with IAA, and its importance in determining the indications for timely correction of minimally invasive inflammatory focus drainage.

Materials and methods. Тhe study included 89 patients with IAA treated by percutaneous drainage under ultrasound control at the surgical department of Stavropol Krai State Healthcare Institution City Clinical Hospital of Emergency Medical Care in the period from 2019 to 2024. The contents of the abscesses were collected on the 1^st, 3^rd, 10^th days followed by bacteriological examination of the material for aerobic and facultative anaerobic flora with determination of sensitivity to antibiotics.

Results. According to the bacteriological examination of the contents of abscesses taken on the first day, the growth of microorganisms was detected in 75 (84,3 %) patients, with E. coli prevailing (46,1 %).

On the third day, the growth of microorganisms was revealed in 77 (86,5 %) patients. At the same time, associations of microorganisms with stable hospital microflora with high antibiotic resistance were found in 18 (20,2 %) of 89 patients.

In 31 (34,8 %) cases, including 18 (20,2 %) people with stable hospital microflora and high antibiotic resistance, antibiotic therapy was adjusted. And it was not adjusted in 58 (65,2 %) patients.

In 16 (18,0 %) patients out of 89, additional measures to ensure effective drainage of the abscess cavity were required. All of them belonged to the group of 18 (20,2 %) people with stable hospital microflora and high antibiotic resistance.

Conclusions. In the majority of patients (65,2 %) with IAA, adjustment of empirical antibiotic therapy was not required, which confirms the primary importance of the effective initial IAA drainage in the treatment, regardless of the size, location, and etiology of the abscess. There is a direct dependence of the microbial landscape of abscesses on the effectiveness of drainage: in case of impaired outflow of contents, insufficient debridement of the abscess, on the third day, the microflora changes to polyresistant hospital strains.

Dynamic microbiological monitoring data can serve as an important criterion for the effectiveness of initial drainage, as well as a predictor dictating the need to correct the drains position or additional drainage of the IAA.