The aim of the research was to investigate the microbial spectre of tertiary peritonits (TP) and its antibiotic resistance as the way to improve the diagnostics and treatment of TP. Materials and methods. Prospective research enrolled 109 patients with secondary peritonitis. Tertiary peritonitis developed in 18,3 % of cases. Samples of peritoneal exudate had been drawn upon index operation, relaparotomy and on the day of diagnosis of TP. Blood sampling was performed in patients with persistent fever, impaired consciousness, prolonged (>4 days) discharge from drainage tubes and on the 1st day of diagnosis of TP. Antibacterial susceptibility was evaluated using Hinton-Müller media. Results and discussion. Patients were divided into 2 groups: with secondary peritonitis (89) and with TP (20). In TP group, cultivation of 76,2 % of primary specimens resulted in replantable and identifiable growth, presenting a shift towards Gram-negative flora and higher incidence of Candida albicans. Following the development of TP, hemocultures were positive in 15,1 %, presented mainly by Proteus spp. and non-albicans Candida spp. Second-group carbapenems, tigecycline and piperacillin-tazobactam had shown the highest activity in pathogens of TP. Caspofungin proved to be the most potent antifungal agent, especially towards non-albicans Candida spp. Antibiotic resistance in TP group was marked in 63,8 %. Conclusions. Tertiary peritonitis is one of the most severe forms of abdominal sepsis with highest mortality. Causing pathogenic flora in case of TP is mainly Gram-negative and coccal with high rates of antibiotic resistance both in vitro and in vivo. Fungi, presented predominantly by Candida non-albicans substrains, show an increasing content in peritoneal exudate and major effect upon mortality in TP. In case of TP, a significant percent of peritoneal specimens do not provide any culture growth despite of observing stringent sampling, transportation and cultivation rules. Antimicrobial therapy of TP can never be standardized and should always be thoroughly based upon regular and proper peritoneal and blood sampling.

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Ïðîàíàë³çîâàíî ðåçóëüòàòè ë³êóâàííÿ 133 õâîðèõ ³ç âèðàçêîâèìè ãàñòðîäóîäåíàëüíèìè êðîâîòå÷àìè (ÂÃÄÊ) çà ïåð³îä 20002004 ðð., ç íèõ 81 õâîðèé íà öóêðîâèé ä³àáåò 2 òèïó (ÖÄ). Âñòàíîâëåíî, ùî äëÿ õâîðèõ íà ÖÄ ³ç íåñòàá³ëüíèì ãåìîñòàçîì (ÍÃ) ó âèðàçö³ áóëè õàðàêòåðíèìè á³ëüøà ÷àñòêà ïàö³ºíò³â ³ç òÿaeêèì ñòóïåíåì ØÊÊ (55,1 ïðîòè 36,4 % õâîðèõ ³ç Íà êîíòðîëüíî¿ ãðóïè; ð<0,05). Ó õâîðèõ íà ÖÄ ïðè ÂÃÄÊ ïîì³ðíîãî òà ñåðåäíüîãî ñòóïåí³â âèÿâëÿëè ïåðåâàaeíî ñòèãìàòè F IIa (ð<0,05), à ïðè òÿaeêîìó ñòóïåí³ êðîâîâòðàòè F IIb (ð<0,05), âîäíî÷àñ áóâ ìàêñèìàëüíèì â³äñîòîê F I (ð<0,05). Çàñòîñóâàííÿ Åà ó 52,3 % õâîðèõ íà ÖÄ ç åíäîñêîï³÷íèìè ñòèãìàòàìè òðèâàþ÷î¿ êðîâîòå÷³ òà íåñòàá³ëüíîãî ãåìîñòàçó äîçâîëèëî çóïèíèòè êðîâîòå÷ó, ïðîâåñòè ïðîô³ëàêòèêó ¿¿ ðåöèäèâó é óíèêíóòè íåâ³äêëàäíî¿ îïåðàö³¿.We investigated the results of treatment of 133 patients with ulcerous gastroduodenal bleeding (UGDÂ) for the period 2000-2004, 81 of them has 2 type diabetes mellitus (DM). It was found out that diabetic patients with unstable hemostasis (UH) in the ulcer were characterized by higher proportion of patients with severe gastrointestinal (55.1% vs. 36.4% of patients with UH control group, p <0.05). In diabetic patients with moderate and medium UGD showed mainly stigmata F IIa (p <0.05), with severe UGD F IIa (p <0.05), while the highest percentage was F I (p <0.05). The use of EG in 52.3 % of diabetic patients with high-risk lesion (endoscopic stigmata of active bleeding, adherent clot or non-bleeding visible vessel) allowed to stop the bleeding, to prevent its recurrence and to avoid urgent surgery.Ïîñòàíîâêà ïðîáëåìè ³ àíàë³ç îñòàíí³õ äîñë³äaeåíü òà ïóáë³êàö³é. Íåçâàaeàþ÷è íà ïî-òóaeíèé ïðîãðåñ ñâ³òîâî¿ ìåäèöèíè ó êîíñåðâàòèâ-íîìó òà õ³ðóðã³÷íîìó ë³êóâàíí³ âèðàçêîâî¿ õâîðîáè (ÂÕ) øëóíêà ³ äâàíàäöÿòèïàëî¿ êèøêè (ÄÏÊ), âè-ðàçêîâ³ ãàñòðîäóîäåíàëüí³ êðîâîòå÷³ (ÂÃÄÊ) ïðî-äîâaeóþòü ïîñ³äàòè ÷³ëüíå ì³ñöå ó ñòðóêòóð³ ãîñ-òðî¿ õ³ðóðã³÷íî¿ ïàòîëî㳿, âîäíî÷àñ ñóïðîâîäaeóþ-÷èñü çíà÷íèì ð³âíåì ëåòàëüíîñò³ [1,3,5,7]. ÂÃÄÊ º îäíèì ³ç íàé÷àñò³øèõ íåâ³äêëàäíèõ ñòàí³â ó ïðàê-òèö³ õ³ðóðã³â òà åíäîñêîï³ñò³â [1,3, 58].Íà äàíèé ÷àñ ó ðîçâèíåíèõ êðà¿íàõ â³äçíà÷åíî çðîñòàííÿ ÷àñòîòè ÂÃÄÊ íà ôîí³ ñòàð³ííÿ íàñåëåí-íÿ, íàðîñòàííÿ ìíîaeèííî¿ ñóïóòíüî¿ õðîí³÷íî¿ ïà-òîëî㳿, ïàíäåì³÷íîãî çá³ëüøåííÿ ÷èñëà õâîðèõ íà öóêðîâèé ä³àáåò (ÖÄ) 2 òèïó [2, 610]. Çà äàíèìè îêðåìèõ äîñë³äíèê³â, ÖÄ º ÷èííèêîì ðèçèêó êðîâî-òå÷³ ïðè ÂÕ, ÷àñòîòà ÂÃÄÊ ó õâîðèõ íà ÖÄ ñÿãຠ10 %, à ëåòàëüí³ñòü 16,6 % [10].Ïîðÿä ³ç íàÿâí³ñòþ ÷èñëåííèõ äîñë³äaeåíü òà äåòàëüíî ðîçðîáëåíèõ íàñòàíîâ ùîäî åíäîñêîï³÷-íî¿ ä³àãíîñòèêè ³ ë³êóâàííÿ ÂÃÄÊ ³ç ð³çíèìè âà-ð³àíòàìè åíäîñêîï³÷íîãî ãåìîñòàçó, ïðîãíîçó ðå-öèäèâó êðîâîòå÷³, îá´ðóíòóâàííÿì âèáîðó ë³êó-âàëüíî¿ òàêòèêè, à òàêîae äîñòàòíüî âèâ÷åíèì ïèòàííÿì ôóíêö³îíàëüíèõ òà ïàòîìîðôîëîã³÷íèõ çì³í ïðè ÂÕ øëóíêà ³ ÄÏÊ ó õâîðèõ íà ÖÄ, ðå-çóëüòàòè ë³êóâàííÿ ÂÃÄÊ ó õâîðèõ íà ÖÄ äàëåê³ â³ä î÷³êóâàíèõ [1,3, 57]. Ðîáîòè ç âèâ÷åííÿ åí-äîñêîï³÷íèõ îñîáëèâîñòåé ÂÃÄÊ ïðè ÖÄ ïî-îäèíîê³, îñîáëèâîñò³ åíäîñêîï³÷íîãî ãåìîñòàçó âèñâ³òëåí³ íåäîñòàòíüî [2, 810].Îö³íêà íàä³éíîñò³ ã...