Modern approach to antibacterial therapy in the practice of a surgeon

Relevance. Currently, all over the world, antibacterial therapy is widely used as a prophylaxis after surgical interventions. Currently, some data indicate the benefits of a short course, while others, in turn, indicate the benefits of a long course of antibacterial drugs as a prevention of postoperative complications. The problem of pan-resistance of bacterial strains in relation to almost all available groups of antibacterial drugs forces us to look for ways to overcome resistance, to look for new potential bases for the creation of antimicrobial drugs. New antibacterial drugs: odilorhabdins, tridecapeptins and malacidins, arilomycins and others will help to overcome the existing difficulties.

The purpose of this study is to analyze the domestic and foreign literature for the period 2017–2021 in order to study the current approach to antibacterial therapy in surgical practice.

Material and methods. In the course of this study, publications were selected according to the topic for the period from 2017 to 2021. The information was obtained from foreign and domestic sources: the Russian scientific electronic library, integrated with the Russian Science Citation Index (eLibrary.ru), Medline database (via Pubmed.gov), Scopus database, ScienceDirect database.

Results. One of the significant difficulties in the treatment of wounds with antibacterial drugs of various localizations is the persistence of resistant strains of Staphylococcus aureus. In the studied studies, the high effectiveness of tedizolide phosphate in the treatment of this type of infection was noted. It is also possible to use other new drugs as epmiric therapy in the presence of risk factors for MRSA infection: daptomycin (lipopeptides), ceftaroline (cephalosporins), tigecycline (glycylcyclines), telavancin (glycopeptides)[41]. The use of biocides in the treatment of prostheses for hernioplasty as an antibacterial prophylaxis significantly reduces the adhesion of staphylococci and prevents postoperative complications. Suture material with antimicrobial activity, which would allow to fully reduce the risk of infections in the field of surgical intervention, is not yet available on the pharmaceutical market, but the increasing attention of scientists is attracted by chitosan, a derivative of the natural polymer chitin. The combined use of bacteriophages with low doses of antibiotics leads to better results in the treatment of surgical soft tissue infection. Bacteriophages are one of the ways to overcome antibiotic resistance.

Conclusions. The modern approach to antibacterial therapy in surgical practice involves the correct and timely appointment of starting therapy, taking into account the sensitivity of microorganisms, the use of antibacterial preoperative prevention, determining the optimal duration of use and dose selection of an antibiotic, the use of sensitive bacteriophages together with them, overcoming antibiotic resistance due to the competent use of new antibacterial drugs based on peptides, a comprehensive approach to the treatment of surgical infection.

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