BackgroundAntimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.MethodsA cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.ResultsThe response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%).ConclusionThe survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-017-0145-2) contains supplementary material, which is available to authorized users.

The microorganisms that are formed in biofilm cause about 60% of chronic and recurrent diseases, and as a consequence, traditional etiotropic antibacterial therapy is ineffective. Chronic anal fissures are also a disease which is caused by biofilm forms of bacteria, has a chronic course and is difficult to treat. The sensitivity of planktonic and biofilm forms of bacteria isolated from chronic anal fissures to antibacterial drugs was determined and the method of degradation of biofilm by electrophoresis for the effective treatment of fissures was developed. It was found that the most effective antibiotics against planktonic forms of bacteria were cephalosporins III and IV generations: cefеpime, cefoperazone and ceftazidime. Exceptionally, only bacteria of the genus Enterococcus, which were sensitive to ceftazidime, were found to be 38.9%. The sensitivity of the bacteria to Furamag was from 60.0% to 100.0%, and only P. aeruginosa exhibited resistance in 100.0% of the studied cultures. The number of sensitive to gatifloxacin strains of P. aeruginosa and Enterobacter spp. was 71.4%, all other isolated bacteria were sensitive to this preparation from 77.8% to 100.0%. Among the five studied antiseptics (chlorhexidine, decasan, octinisept, povidone iodine, dioxidine), the greatest antimicrobial activity was found in dioxidine and betadine (povidone iodine) solutions, the sensitivity of the microflora was from 60.0% to 100.0%. We found that the most protected biofilm matrix was P. aeruginosa and Enterococcus spp. We found that the antibiotic which had the best effect on cells in biofilm was fluoroquinoione gatifloxacin. After its influence on the biofilm P. aeruginosa and Enterococcus spp., the number of living cells didn’t exceed lg 1.5 ± 0.02 CFU/cm2 in the area of the biofilm, and S. aureus and E. coli cells were completely inactivated. After the influence of other antibiotics, the number of microbial cells that survived in the biofilm did not exceed lg 2.9 ± 1.6 CFU/cm2 of the area. It was found that after the action of dioxin, the amount of viable microbial cells was up to lg 2.9 ± 1.7 CFU/cm2 of biofilm area. Antiseptics: octine septum, ranopost, decaSan and chlorhexidine exhibited less strong bactericidal action on cells in biofilms, and the number of bacteria that survived after their action ranged from 2.9 ± 1.8 to lg 3.7 ± 2.1 CFU/cm2 of biofilm area. We propose using solution "Dioxysol-Darnitsa" (active substance dioxidine) for local treatment of patients with chronic anal fissures for intracutaneous electrophoresis of the fissure. We established that under the influence of electrophoresis at a current of 0.05–0.10 mA/cm2 of the area of the biofilm with dioxidine, bacteria were not isolated. This indicates on the destruction of the matrix and the effective contact of dioxidine with microbial cells and the manifestation of bactericidal action. Consequently, laboratory microbiological studies indicate that the use of electrophoresis with dioxysole in the treatment of chronic anal fissures is promising.

Topicality. Using generally accepted methods of calculating doses of local anesthetic during spinal anesthesia, the efficiency and safety of anesthesia are not always sufficient. The aim of our study was to determine the optimal dose of local anesthetic according to the height of the patient gradation method for unilateral and bilateral spinal anesthesia during orthopedic and traumatological operations on the lower extremities. Determine the advantages and disadvantages of both methods of analgesia. Materials and methods: Our study is based on an examination of 52 patients of I-II degrees of surgical risk according to ASA, divided into two groups. The first group (control) included 25 patients who underwent bilateral spinal anesthesia, the second group included 27 patients who underwent unilateral spinal anesthesia during orthopedic and traumatological operations on the lower extremities. Spinal anesthesia was performed with a hyperbaric solution of 0.5% bupivacaine, with the anesthetic dosing algorithm developed by us. Results: When evaluating the effectiveness of the performed spinal anesthesia, the duration of sensory and motor blocks and the level of development of sensory blockade by dermatomes in both study groups were determined. In the 1st group, the sensory block was 252.2±74.32 min., the motor block was 198.2±59 min. In the II group, the sensory block was 189.25±34.27 min., the motor block was 154.07±28.59 min. When determining the frequency of cardiovascular complications, dynamics of indicators in mean arterial pressure (MAP) and heart rate (HR) were determined before surgery, after 5 min., 30 min., 1 h., 2 h., 3 h., 5 h., 7 h., 9 h. It was found that the decrease in MAP and heart rate prevailed in the first group during the study. The volume of crystalloid infusion in the first research group was 2042±663.9 ml, and in the second group – 1666.66±635.49 ml. Laboratory diagnostic methods were used in order to determine dynamics of indicators in the basic metabolism and hormonal background during the occurrence of pain syndrome in patients and the effect of the dose of local anesthetic on the speed and level of changes in these parameters. For this purpose, changes in blood glucose, lactate and blood cortisol were determined before surgery, 3 hours, 6 hours and 9 hours of anesthesia course. Conclusions: 1. Gradational dosing of local anesthetic for unilateral and bilateral spinal anesthesia according to height ensures the necessary effectiveness of analgesia. 2. Reducing the dose of anesthetic during unilateral spinal anesthesia increases the safety of anesthesia and causes less side effects. 3. The duration and level of sensory blockade of unilateral spinal anesthesia is significantly reduced when using a reduced dose of local anesthetic in comparison with bilateral.

A positive result of treatment of patients suffering from ischemic-gangrenous form ofdiabetic foot syndrome (DFS) becomes possible with an optimal choice of surgery,effective renewal of blood supply and active stimulation of tissue restoration processon the cellular level.Objective – to study efficiency of the suggested organ-saving variant of surgery combinedwith the use of a complex of auxiliary factors of a reparative process activation in thewound including regional ozone therapy, vacuum sanitation and local application ofautologous platelet-rich plasma (PRP).Material and methods. The treatment of 210 patients with ischemic-gangrenous formof diabetic foot syndrome was carried out from 2017 to 2020. The efficiency of one ofthe variants of organ-saving operative intervention was studied. In the control group -104 (49.52%), the treatment was carried out in accordance with the standard scheme.In the main group (106 patients - 50.47%), in addition to the standard scheme, regionalozone therapy, vacuum sanitation and local application of autologous-rich plasma(PRP) were carried out.Results. These measures reduced the period of treatment of patients in the hospital to24 ± 1.2 days in the main group compared to 37 ± 2, 4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones.Conclusions. The suggested modification of the organ-saving and partial foot amputationin patients with IV degree of ischemia and DFS is indicative of a possibility to performsuch kind of surgery as a variant of choice for patients with ischemic-gangrenousform of diabetic foot syndrome. The complex of auxiliary measures (regional ozonetherapy, vacuum sanitation and local administration of autologous platelet-rich plasma(APRP)), activates a reparative process of healing of a chronic foot wound whichenables to make the period of hospital staying for patients shorter – to 24±1,2 days inthe main group as compared to 37±2,4 days in the control one. Clinical observation ofa remote postoperative period (2 years later) confirms a possibility to form a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones, functionally advantageous for supporting load.

високий відсоток незадовільних результатів хірургічного лікування хронічних анальних тріщин (ХАТ), низькі показники якості життя та потребу в післяопераційній (п/о) реабілітації таких пацієнтів, метою роботи було поліпшити результати хірургічного лікування ХАТ завдяки оптимізації ведення раннього п/о періоду. Нами обстежено 68 пацієнтів на ХАТ. В основній групі в п/о періоді, починаючи з 2-ої доби, проводили внутрішньотканинний електрофорез від 3 до 5 разів із розчином «Діоксизоль®-Дарниця» густиною струму 0,05 мА/см 2 , експозиція 60 хвилин, у контрольнійзастосовували стандартні методи ведення п/о періоду. Інтенсивність больового синдрому суттєво зменшувалася вже з третьої доби після операції у пацієнтів, яким з 2-ої п/о доби проводили сеанси гальванізації, також упродовж усього терміну раннього п/о періоду, рівень болю був завжди суттєво нижчим, ніж у хворих контрольної групи. Якщо на першу добу після операції усі хворі потребували знеболювання, при цьому значна частина отримувала наркотичні анальгетики, то на третю добу лише 4 (11,43 %) хворих основної групи отримували знеболення, на відміну від усіх пацієнтів (100 %) контрольної групи, а на четверту добу основна група не потребувала знеболення, коли в контрольній групі 28 хворих (84,85%) ще застосовували знеболення. Оцінюючи п/о період та віддалені результати лікування, за всіма критеріями ефективність лікувальної тактики у основній групі є вищою. Зокрема, рецидив тріщини траплявся в 2,32 раза частіше у контролі. Також вдалося скоротити на 2,66 доби термін повного загоєння рани. Використання внутрішньотканинного електрофорезу у пацієнтів у ранньому п/о періоді після хірургічного лікування ХАТ підвищує ефективність лікування на 31%, в 1,2-1,3 рази покращує усі показники якості життя пацієнтів, сприяє швидкому відновленню післяопераційного лікування, зменшує частоту ранніх та пізніх п/о ускладнень. Ключові слова: хронічна анальна тріщина, внутрішньотканинний електрофорез, післяопераційний період.