. « » – ( ). 146 - , ( ), . ( , 65 ). . , Expression. (53,3%) Acinetobacter baumannii. 33,3% - . : , , , , - . The article is devoted to the problem of diagnostics and treatment of the most widely spread intracranial pyo-inflammatory complications – to meningoencephalitis ( E). The death rate at the given pathology reaches 20-30 %. The analysis of 146 cases of the patients with postoperative E, who were operated on with severe cranial-cerebral traumas, diseases of the brain and vascular pathology is presented in the article. It is shown, that priority value in diagnostics and treatment of the patients with ME belongs to studying of the structure of the cerebrospinal fluid (CSF). Bacteriological studying of CSF in 65 patients was performed. Identification and estimation of microorganisms sensitivity was carried out by means of the tests - systems on the biochemical analyzer ATB Expression. The growing role of gram negative polyresistant microflora (53,3 %) in the etiological structure of the postoperative E was proved; 33,3 % of cases of them were caused by Acinetobacter baumannii. On the basis of the data concerning the structure and sensitivity to antibiotics, circuitries of the rational antibiotic therapy of E in the neurosurgical patients are developed. Keywords: meningoencephalitis, diagnostics, polyresistant flora, antibiotic therapy, prophylaxis. - , [8, 11]. [2, 4]. 12 40% - . , 106 - 5,5%, - 3 2008 16 – 20%. [11,15,19]. 30% [8,13]. Expression . , - [4]. , - , , Excel 7. (Microsoft, USA) Statistica 6.0 (Stat Soft, USA) [14]. [3, 6]. 2000 – 2007 : - . , , . " 146 54 (36,9%), 18 ), . 1). , , ( " .( (47,2%) - . 14 (9,5%) , , , 6 (4,1%) 3 (2%) . , . , – 74 , [9]. . 106 (72,6%) 4–9 - , , 69 - , - . 131 (89,7%) . . 1. . (n=146) 30 - 25 20 15 ( , ( ( - ), ), . 9 6 5 10 5 12 10 5 18 10 12 7 10 7 10 7 13 5 0 , - 2000 2001 2002 2003 2004 2005 2006 2007 107 , 108 , – 14 - , 3 6 - . 37 [11, 13]. 100– , . 146 79, 54,1%, 2001 2007 – 27,7%. ( . 2). . 70,5%, . - 38,2±1,05O , 120 ./ , ( – 13,4±3,9 109/ , 13±6%, 81±13%, 7±4%, – 32,2±17,5 ). - , , - . , , , , , , - - . , - . . , - , [19]. , , - , , . - . . 2. . , , (n=146) , ( 80 , 70,5 ,% 70 60 , ) 66,6 58,3 62,5 . 58,8 50 45,5 40 , 41,1 30 27,7 20 2000 2001 2002 2003 2004 2005 2006 2007 ( , [1, 9]. ), . 108 - 3 2008 16 37 (42,19%), . - , . (57,81%), , , . - , 27 . , , 29 . , , , , - , [5, 8, 18]. (78,37%) , 8 (21,62%) . . , 205±25 . , . 4 , , . 0,66 – 15,6 – 4 . - - . 1 37 . 19000 5235 ., . , – : , – 1 . , . . . - (78,37%), 45 Staphylococcus – 13 (28,8%), Streptococcaceae –8 (17,7%), Enterobacteriaceae – 5 (11,1%), Pseudomonadaceae – 4 (8,8%), - 15 (33,3%) ( . 3). S. aureus – 4 (30,7%) ( ): S. saprophyticus – 4 (30,7%), S. pidermidis – 5 (38,4%). Enterococcus Spp. – 4 (50%), Streptococcus – 2 (25%) 2 (25%) Aerococcus viridans. E.coli – 2 – 1 (20%) 2 . . (40%), P.vulgaris (40%) Klebsiella spp. . 64 , P.aeruginosa, Acinetobacter baumannii. 109 Streptococcaceae 17,77% Enterobacteriaceae 11,11% Pseudomonadaceae 8,88% Staphylococcus 28,88% 33,33% 3. . Acinetobacter baumannii ( <0,01), S. ureus ( <0,01). , , 53,3 % . (33,3%) Acinetobacter baumannii <0,01). - (66,6%), (60%), . . - (87,5%), , . , (58,3%), (50%), , (71,4%), 110 . , (83,3%), , , , (100%) , , - , (75%) - , , (50%), (80%) , (33,3%) , , (66,6%), (50%), (33,3%). , , (75%), (66,6%), , (80%) , , (75%), (66,6%), , (50%) (40%), (25%). , (60%), , [3, 5, 6, 24]. . (100%) (62,5%), (33,3%) , - , (60%) (53,3%), (42,7%), (40%) , . 100% (66,66%), , (50%), - , - 3 2008 16 , , (0%) , [8, 23]. . , , - , , , , , , , III , , , , , , - , . , , , , , , , , , , ( [20, 21]. - ), [21]. , , , , , , , , , . , [7]. , - , [3, 6]. - , [9, 15]. [10-12, 22]. [2, 9, 23]. ( ), - - , , . , [10, 22]. - [8, 12, 16]. - , , , ( - , , .) [5, 12]. [10, 16, 22, 23]. , - - . [17]. - , , , - , 111 1 1 2 III ( , )± ; ; ; , ); ); III ( ; , ; )± , ); ); III ( , ; )± ; ) III ), ± ± , ); ) ± ± + ; ± ) , III ( ; , + ), ) ; + ; ) 78,37%, ( 1). 1. - 57,81% . 2. 112 21,63%. , 53,3 % . 33,3% Acinetobacter baumannii (p<0,01). , , , . 3. - 3 2008 16 , , 70,5% (2001 .) (2007 .), 1. , . .– 3. . . , . . : : , . . 2. : 27,7% , . - / . . // III .– ., 2002. – . 4. / . . , 1995. – 79 . , . . , . - , . . . / . . , . . , . . ; . . . .– : , 2002. – 600 . 4. , . . / . . , . . , . . // . . . – 1997. – 4. – . 46-49. 5. / . . [ .] // .2001. – 1(5). – . 3-5. 6. , . . / . . .– .: . , 2003. – 150 . 7. , . . / . . , . . , . . // . – 2006. – 1. – . 18-23. 8. , . . / . . , . . . – .: " ", 2000. – 567 . 9. , . . / . . , . . // : VII . .– ., 2004. – . 44-45. 10. : . ./ . . . – ., , 1997. – 640 . 11. :c . [ .]. – .: " 1993. – 351 . 12. : / . . . .– 2002. – 648 . 13. , . , / . . – 2000. – 1. – . 34-37. 14. , . / . . – ., – 312 . 15. , . . . . 16. ; . / . . ", – .: // . . . .– ., 2001. – . 2. – 324 . , . - , 2002. / - , . . - / . . [ .] // III : : .– ., 2002. – . 444. 17. Andes, D. R. Pharmacokinetics and pharmacodynamics of antibiotics in meningitis / D. R. Andes, W. A. Craig // Infect. Dis. Clin. North. Am. – 1999. – Vol. 13, N 3. – P. 585-618. 18. Buckwold, F. J. Hospital-acquired bacterial meningitis in neurosurgical patients / F. J. Buckwold, R. Hand, R. R. Hansebout // J. Neurosurgery. – 1977. – Vol. 6, N 4. – P. 494-500. 19. Chowdhuru, M. N. Antibacterial agents in infections of the central nervous system / M. N. Chowdhuru, A. R. Tunkel // Infect. Dis. Clin. North. Am. – 2000. – Vol. 14, N 2. – P. 391-408. 20. Garvey, G. Current concepts of bacterial infections of the central nervous system / G. Garvey // J. Neurosurg. – 1983. – Vol. 59. – P. 735-744. 21. Gorbach, S. L. Pocket Book of Antimicrobial Therapy & Prevention / S. L. Gorbach, J. Mensa, J. M. Gatell. – 1997. – 315 . 22. Hughes, R. Neurological Emergencies / R. Hughes. – 4-th ed. – London, 2003. – 479 . 23. Tauber, M. G. General principies of therapy of pyogenic meningitis / M. G. Tauber, M. A. Sande // Infect. Dis. Clin. North. Am. – 1990. – Vol. 4, N 4. – P. 661-676. 24. , D. Use antibacterial agents in infections of the central nervous systems / D. , . rz // Infect. Dis. Clin. North. Am. – 1999. – Vol. 3, N 3. – P. 555-570. 23.05.2008 . 113