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Intraperitoneal enzymoantibioticotherapy in diffuse peritonitis


Author: Lepadatu Corneliu
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2009
Scientific adviser: Eugen Maloman
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.27
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 4 November, 2009
Approved by NCAA on the 17 December, 2009

Abstract

Adobe PDF document0.43 Mb / in romanian

Keywords

local enzymotherapy, diffuse peritonitis, intra-abdominal infection, peritoneal biofilm, peritoneal lavage. Study domain: surgical treatment of severe intra-abdomianl infection

Summary

The thesis includes introduction, six chapters, conclusions and practice recommendations. It is exposed over 120 of typed pages, contains 27 tables, 20 figures. References include 222 of sources. Results of the study were published in 14 articles.

Goal of the study is improvement of treatment results in patients with diffuse secondary peritonitis by intra- and postoperative lavage with solution of trypsin/ciprofloxacine/metronidazole.

Objectives of the study. Evaluation of clinical efficiency and therapeutic safety of the local treatment of diffuse peritonitis with enzyme-antibiotic combination by the means of the experimental and clinical studies; study of the peritoneal biofilms in diffuse peritonitis as the eventual target for the intraperitoneal therapy with antibiotic-enzyme solution.

Scientific novelty. This is the first time, when the enhancement of ciprofloxacine by trypsin was shown on the reference and clinical cultures of E. coli, Ps. aeruginosa and Staph. aureus by the determination of MIC and MBC using standard method. In this work the presence and evolution of peritoneal biofilms were shown for the first time relying on electronic microscopy data. In the laboratory study the optimal composition of enzyme/antibiotic solution for the efficient and safe peritoneal lavage was determined. Experimental and clinical study confirmed positive therapeutic effect of the trypsin/ ciprofloxacine/ metronidazole lavage solution in patients with diffuse peritonitis.

Practical value of the study. Clinical part of the work is based on the surgical practice. During this study improved recovery rate and low postoperative lethality was obtained in patients with unfavorable prognosis. Introduction in surgical practice of peritoneal biofilm concept, which is argued in the preclinical part of the study, will promote use of biofilm-eradicating agents in treatment of patients with intra-abdominal infections. The method of local therapy with enzyme-antibiotic solution applied in accordance with elaborated recommendations will significantly improve the results of treatment of patients with diffuse peritonitis.