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The purified preparations of Klebsiella bacteriophages, viz. the monovalent preparation of K. pneumoniae bacteriophage and the polyvalent bacteriophage preparation for the treatment of infections caused by K. ozaenae, K. rhinoscleromatis scleromatis and K. pneumoniae sensu lato, have been obtained. The bacteriophage preparations have proved to be nontoxic and safe for laboratory animals after the intraperitoneal injection of these preparations followed by the pathomorphological study of the internal organs of the animals. The clinical study of the newly developed bacteriophage preparations in the course of the treatment of purulent inflammatory diseases in 109 patients has revealed that the preparations are not reactogenic and exhibit sufficient effectiveness in the therapy of ozena, rhinoscleroma and Klebsiella infections with different localization of the infectious process.

Bacterial flora in pathological excreta of cancer patients and sanitary analysis specimens was compared. Enterobacteriaceae (Escherichia coli, Klebsiellas, Proteus, etc.)--34.8 staphylococci--25, enterococci--14.7 and Pseudomonas aeruginosa--7.6% were chiefly responsible for infection--induced complications in both study groups. Among the factors of infection development were severity of malignant disease, immunosuppressive effects of present-day methods of cancer treatment, inadequate sanitary-hygienic conditions, problems involved in sterilization of certain types of diagnostic and therapeutical equipment and a large-scale application of antibiotics which is conductive to selection of multiple resistant bacteria. Procedures for equipment sterilization and use of antibiotics are discussed.

The biochemical identification and serological typing of 104 Klebsiella pneumoniae strains isolated from oncological patients in cases of purulent septic complications were carried out with the use of agglutinating K-sera prepared at the All-Union Escherichia Center. According to the character of K-antigens contained in these strains they were found to belong to 27 serovars. 6 strains proved to be in the R-form, and the typing of 7 strains could not be carried out with the set of sera used in this investigation. In different kinds of pathological material definite K-serovars prevailed. The sensitivity of the isolated K. pneumoniae strains to 21 antibacterial preparations was studied; as a result, sensitivity to gentamicin was observed in 78%, to dioxydin, in 73% and to chloramphenicol, in 65.5% of these strains. Some specific features characteristic of the course of Klebsiella infection in oncological patients were revealed: in one patient K. pneumoniae cultures belonging to the same K-serovars could be isolated from different foci of infection, while those belonging to different K-serovars could be isolated from the same focus of infection. The analysis of different medical histories yielded results demonstrating that in oncological patients Klebsiella infection took a prolonged and severe course, frequently with fatal termination, thus bringing to naught successes achieved in specific antitumoral treatment.

The authors assess the efficacy of phage therapy ofsuppurative and inflammatory complications in oncological patients. A clinical and laboratory analysis has involved 131 patients whose etiotropic therapy consisted of bacteriophages (65 patients) and antibiotics (66). Medicinal phages, manufactured by the Tbilisi Research Institute for Vaccines and Sera, have been administered according to 3 schemes: (1) parallel with antibiotics, (2) after long ineffective antibiotic therapy, (3) phages alone starting from the onset of the purulent complication. The preparations have been prescribed with due consideration for the isolated microflora sensitivity. Incorporation of phages in combined therapy of infectious complications has yielded positive results in 81.5% of cases, whereas antibiotics have proved effective in but 60.6%. The efficacy of phage therapy depends on the type of pyoinflammatory complications (the results are the best in the management of wound infections), the microflora pattern of the purulent foci (phages are the most effective with a corresponding monoinfection), characteristics of the therapeutic phages proper (Pseudomonas aeruginosa phage is characterized by the highest therapeutic activity, as compared to staphylococcal and other phages).

The flora isolated from cancer patients in cases of infectious complications has been found to consist of Gram-negative bacteria. Of 414 isolated Gram-negative bacteria strains, 369 strains belonged to the family Enterobacteriaceae, 38 strains to the family Pseudomonaceae, and 7 strains to other families. Enterobacteria were mainly represented by bacteria of the tribes Escherichieae, Klebsielleae, Proteeae. The prominence of individual species in different infectious complication has proved to depend on their localization. Thus, Kl. pneumoniae show a distinct prevalence in purulent septic complications of the respiratory organs, in most of other infections E. coli have been found to play the dominating role. This study demonstrates the etiological role of enterobacteria in hospital infections in patients with malignant tumors.