Antibiotiklar va bakteriofag terapiyasi jarrohlik sohasi infeksiyalarining oldini olish va davolashda: dalillarni tizimli xaritalash sharhi hamda xavfsizlik va natijalar bo‘yicha tavsifiy umumlashtirish
Qabul qilingan: 2026-01-10 05:03:26
Nashr etilgan: 2026-04-30
Annotatsiya
Maqsad. Jarrohlik sohasi infeksiyasi (SSI) muhim operatsiyadan keyingi asorat bo‘lib qolmoqda va yarani uzoq muddat parvarish qilish, antibiotiklar ta’siri, antimikrob rezistentlik hamda sog‘liqni saqlash xarajatlarining oshishiga sabab bo‘ladi. Bakteriofag terapiyasi maqsadli antibakterial yondashuv sifatida qayta dolzarblik kasb etmoqda, biroq mavjud klinik adabiyotlar juda turli kontekstlarni, ya’ni odatiy antibiotik profilaktikasidan tortib surunkali, biofilm bilan bog‘liq yoki implantat bilan bog‘liq infeksiyalarni qutqaruv terapiyasigacha bo‘lgan holatlarni qamrab oladi.
Materiallar va usullar. Ushbu maqola to‘liq tizimli sharh yoki meta-tahlil sifatida emas, balki xavfsizlik va natijalar bo‘yicha tavsifiy umumlashtirishlarga ega dalillarni tizimli xaritalash sharhi sifatida taqdim etilgan. Ma’lumotlar bazalarini skrining qilishning to‘liq jurnali, dublikatlarni olib tashlash qaydi, to‘liq matnli maqolalarni chiqarib tashlash ro‘yxati va oldindan hujjatlashtirilgan PRISMA oqim ko‘rsatkichlari mavjud emas edi. Shu sababli, natijalar mavjud barcha adabiyotlarning to‘liq tizimli sintezi sifatida emas, balki ajratib olingan manbalar to‘plamiga asoslangan dalillar xaritasi sifatida talqin qilinishi kerak. Klinik manbalar klinik maqsad bo‘yicha tasniflandi: SSI profilaktikasi, aniqlangan infeksiyani davolash, surunkali yara/diabetik oyoq infeksiyasi va protez bo‘g‘im/implantat bilan bog‘liq infeksiya. Natijalar SSI uchrash tezligi kabi profilaktikaning salbiy natijalariga va yara bitishi, bakteriyalarning yo‘q qilinishi yoki klinik bartaraf etilish kabi davolashning ijobiy natijalariga ajratildi. Metodologik ishonchlilik tadqiqot dizayniga muvofiq RoB 2, ROBINS-I, JBI nazorat ro‘yxatlari, AMSTAR 2 va GRADE tamoyillariga mos prinsiplardan foydalangan holda ko‘rib chiqildi.
Natijalar. Faqat antibiotik profilaktikasiga oid tadqiqotlarda SSI yoki yara infeksiyasi ko‘rsatkichlari turlicha bo‘lib, umumiy jarrohlik profilaktikasida hodisalarning tavsifiy umumlashtirilgan ko‘rsatkichi 11,17% ni tashkil etdi. Faglar bo‘yicha dalillar asosan davolash sharoitlarida jamlangan bo‘lib, yakuniy nuqtalar infeksiyaning bartaraf etilishi, eradikatsiya, bakterial yuklamaning kamayishi yoki yara bitishini o‘z ichiga oldi. Faqat faglar qo‘llangan surunkali yara tadqiqotlarida muvaffaqiyat/bitish/yuklama kamayishi bo‘yicha 80,9% tavsifiy signal qayd etildi, faqat faglar qo‘llangan ortopedik dalillar esa asosan juda kichik klinik holatlar yoki holatlar seriyalariga asoslangan edi. Fag va antibiotik qo‘shib qo‘llangan bitta kichik profilaktika tadqiqotida aralashuv guruhida SSI 13,63% deb xabar qilindi. Ushbu tavsifiy umumlashtirishlar profilaktika va davolash kategoriyalari bo‘yicha bevosita solishtirilmaydi va qiyosiy samaradorlik baholari sifatida talqin qilinmasligi kerak.
Xulosa. Antibiotik profilaktikasi SSI profilaktikasida eng asoslangan yondashuv bo‘lib qolmoqda. Hozirgi klinik dalillar bakteriofag terapiyasi ayrim murakkab, rezistent yoki biofilm bilan bog‘liq infeksiyalarda istiqbolli qo‘shimcha usul bo‘lishi mumkinligini ko‘rsatadi, biroq uning odatiy SSI profilaktikasidagi roli yetarli darajada aniqlanmagan. Mavjud xavfsizlik ma’lumotlari qisqa muddatli ko‘taruvchanlik bo‘yicha umuman ijobiy signalni ko‘rsatadi, ammo bu xulosa kichik tanlamalar, hisobotlarning turlicha bo‘lishi hamda standartlashtirilgan mikrobiom yoki rezistentlik kuzatuvining kamligi bilan cheklangan. Keng perioperatsion joriy etishni tavsiya qilishdan oldin takrorlanadigan qidiruv va hisobot berish mezonlariga ega yirikroq prospektiv nazoratli tadqiqotlar zarur.
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