gms | German Medical Science

Objectives: The aim of the study was to determine the duration of drainage application in postoperative period of spine purulent inflammatory diseases based on determination of D-lactate level.

Methods: A simple, incomparable, prospective study of a series of clinical cases was performed. 27 patients with purulent inflammatory diseases of the spine were operated on from 2017 till September 2018. Nonspecific spondylodiscitis was diagnosed in 23 cases, purulent epiduritis - in 4. The median age of patients was 62 [60-65] years. Surgical treatment included the debridement and active wound drainage. The wound discharge for 1 ,3 , 5 days was studied by the cytological and bacteriological method on the ATB Expression microbiological analyzer (BioMerieux, France). The amount of wound discharge and the level of D - lactate in it were determined (test system „D-Lactam", Republic of Belarus). Statistical analysis was performed in Statistica 10.0. Results were presented as median and maximum and minimum values of Me (max, min).

Results: A decrease in the level of D-lactate in the wound discharge was established on average 1.4-2.5 times for 3-5 days (the median of D-lactate in 1 day was 2.01 mmol / l (max 2.3 mmol / l, min 1.59 mmol / l), on the 3rd day - 1.07 mmol / l, (max 1.40 mmol / l, min 0.38 mmol / l), on the 5th day - 0.68 mmol / l (max 0, 85 mmol / l, min 0.22 mmol / l)) (p <0.05). There was a significant decrease in the volume of discharge from 80 (60-100) ml (1 day) to 6 (4-8) ml (5 days), leukocytes in the exudate from 55 (41-87) to 8 (6-10) cells in the smear. Bacteriological culture on days 2, 3 and 5 was negative. It was an indication for drainage removal. With the increase in the level of D-lactate in the wound exudate (testified to the continuing purulent process), the bacteriological analysis was positive, and a large number of white blood cells (more than 100 cells with a smear) were determined by cytological examination. It was an indication for re-sanitizing operation.

Conclusion: Decreasing of the D-lactate level in the drainage exudate in 1.4-2.5 times indicates the absence of a microbial pathogen and a positive dynamics of reparative process, which allows you to remove the drainage. An increase in the level of D-lactate indicates the presence of a continuing purulent process.