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Results of microbiologie examinations for the detection of anaerobic nonesporulation microflora in trauma and orthopaedic patients with purulent processes are analysed. Out of 308 patients with purulent processes in bones and joints of pelvis and lower limbs anaerobes are detected in 40.6% of cases, i.e. anaerobes only - in 7.5% and anaerobic-aerobic assocoations - in 33.1%. In chronic gunshot osteomyelitis anaerobes are determined most often (in 84.6% of examined patients). Out of 110 patients with suspision to sepsis obligate anaerobes are isolated in 21.8%. Among determined anaerobes coccous microflora makes up 44.16%, bacteroides - 18.7%, fusobacteria - 3.2%, Clostridium - 7.53%, Gram-positive nonesporulation bacilli - 26.41%. Methods of microbiologie diagnosis for anaerobic microflora using both imported and native equipment are described. Peculiarities of clinical manifestation and treatment of anaerobic purulent processes are presented too.

Actual problems of organization and performance of chemoprophylaxis and chemotherapy of surgical opportunistic infections are discussed with an account of the main principles of and new approaches to the use of antibacterial drugs. The analysis of the authors' observations showed that the pre- and postoperative use of parenteral antibacterial drugs such as cephalosporins (cefazolin and ceftriaxone) and their combinations with aminoglycosides, the simultaneous use of beta-lactams and lysozyme, the local application of new ointments based on polyethylenglycol, foaming agents and gentacycol were prophylactically efficient in patients with high risk of surgical infections. Endolymphatic administration of gentamicin and cefotaxime was highly efficient in the treatment and prophylaxis of severe surgical infections with lymphogenous dissemination of the pathogen or its risk. In the prophylaxis of endogenous infections special attention should be paid to the suppression of the opportunistic intestinal microflora by the use of fluorquinolones and selective decontamination followed by the correction of the intestinal microbiocenosis with probiotics (bifidobacteria), lysozyme and immunological lactoglobulins as dosage forms or dry milk biologically active additives to children diet and dietotherapy.

The in vitro studies showed that incubation of S. aureus, P. aeruginosa, E. coli and P. mirabilis in the presence of phosphatidyl choline cholesterol liposomal suspension was accompanied by inhibited microbial growth. The effect was time- and dose-dependent. The arranged structure of the liposomal membranes played an important role in genesis of the bactericidal action of the liposomes since the use of lipids of the same composition in a nonpolysomal form markedly lowered the bactericidal effect.

Studies of antiexudative, antialterative, and antibacterial effects of lecithin-cholesterol liposomes suggest their possible use as antiinflammatory agents. It is shown that incubation of liposomes with opportunistic microorganisms is attended with a pronounced antibacterial effect, while subcutaneous injection of liposomes significantly reduces the soft tissue edema caused by administration of formalin, and prevents pronounced alteration in response to acetic acid solution. A conclusion is derived on the possibility to use the membranotropic properties of liposomal membranes to alleviate manifestations of inflammation.

The data on the use and clinical efficacy of semisynthetic penicillins and cephalosporins in the treatment of the traumatologic and orthopedic patients are summarized.

The ability of various antibiotics to inhibit superoxide anion(O-2)-mediated formation of adrenochrome from adrenaline and recovery of cytochrome c by xanthine oxidase was studied. In the adrenaline system (pH 10.2), aminoglycosides might be arranged, according to the inhibitory effect, in the following order: monomycin greater than gentamicin greater than kanamycin greater than lincomycin greater than streptomycin. In the xanthine oxidase system (pH 7.8), that order was the following: monomycin greater than gentamicin greater than lincomycin greater than greater than kanamycin. It was suggested that the antibiotic inhibition of the O-2-dependent processes at the essential sites of metabolism and/or the antibiotic involvement into the process of free radical oxidation initiated by O-2 in the cells might be one of the mechanisms of the drug action and toxicity with respect to the host.

The procedure of and the data on the bacteriological investigation of the pathological material collected from 178 patients with purulent inflammatory diseases of various localization (mainly of the locomotor system) are presented. Obligate anaerobes were detected in the specimens of the clinical material from 39 per cent of the patients. Antibiotic sensitivity of 62 strains of the obligate anaerobic bacteria was determined. Of the antibiotics tested, levomycetin, carbenicillin and lincomycin proved to be most active against the anaerobes.

During 10 years 1063 patients were treated with lincomycin used parentally or orally at the N. N. Priorov Central Research Institute of Traumatology and Orthopedy. The doses and the rate of its use depended on the state of the patient, its age and weight. Lincomycin was used for the treatment of patients with osteomyelitis or purulent wound infection, as well as for prophylaxis of suppuration. The drug was used for a long period of time under conditions of the same hospital, and it was shown that it remained up to the present days highly effective in therapy of infections and especially bone infections caused by staphylococci sensitive to it. The 10-year study of staphylococcal sensitivity to lincomycin revealed an insignificant increase in the development of resistance to it. The paper presents data on the importance of adequate surgical interventions in addition to the antibiotic therapy in cases with bone infections. A possibility of lincomycin combined use with other antibiotics and gentamicin or kanamycin in particular was shown. Complications, such as diarrhea and urticaria were registered in 11 patients.

Sensitivity of 320 strains of P. aeruginosa to 12 antibiotics was studied. It was shown that tobramycin, gentamicin, polymyxin B, carbenicillin, and combinations of tobramycin and gentamicin with carbenicillin were the most effective. The synergism of the combinations was observed in 100 and 94.7 per cent of patients, respectively. One per cent dioxidine solution was shown to be highly active against 84.7 per cent of P. aeruginosa strains. Sensitivity of P. aeruginosa to surface active substances, such as N-cetylpyridinium chloride (N-CPC), rokkal and chlorhexidine was studied with the method of 2-fold serial dilutions. It was found that 66.6 per cent of the strains were sensitive to N-CPC in dilutions of 1:80--1:160. The respective figures for rokkal and chlorhexidine were 1:10--1:40 and 1:40. The drugs were used in treatment of patients with P. aeruginosa wound infections. Five patients were treated with intraosteal administration of gentamicin in a mixture for prolonged antiinflammation blockade. Investigation of the therapeutic concentrations revealed that high concentrations of gentamicin were attained in the wound even in an hour and maintained for 10 hours. No gentamicin was detected in the wound in 48 hours. The combined use of the antibacterial drugs provided efficacy of the chemotherapy.

Strains of Acinetobacter were shown to be widely distributed in the environment of traumatological and orthopedic hospitals and in clinical pathological materials. This permitted to consider Acinetobacter as an agent causing hospital infections. It was shown that Acinetobacter strains were resistant to the majority of antibacterial drugs. The potential ability of Acinetobacter to transfer resistance plasmids to other strains is of particular danger for distribution of resistant microorganisms in hospitals.

Staphylococci have been mainly isolated presently from the wounds of the traumatological and orthopedic patients. Sensitivity of the out-of hospital and hospital staphylococcal strains was studied. Higher sensitivity of the out-of-hospital strains was showed. Directed antibiotic therapy, control of the treatment courses, doses, drug levels in the blood serum and infection foci provided more effective results in patients with purulent complications.

At present we use antibiotics in treatment of wound infections on the basis of the teaching of Z. V. Ermolyeva on their prophylactic and therapeutic value developed during the Great Patriotic War. We consider that along with thorough primary surgical treatment the use of antibiotics in cases with open fracture is indicated. In "clear" operations on the bones and joints we use antibiotics only in patients with risk of infection. In cases with purulent infection and isolation of multicomponent microbial associations from the wound including also nonsporulating anaerobic organisms we mostly apply combined antibacterial chemotherapy with immunotherapy and surgical treatment.