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Objective: The aim: To clarify the efficacy of probiotics use as a preventive measure for post-antibiotic treatment in acute peritonitis and increase staff awareness related to antibiotic and probiotic use., Patients and Methods: Materials and methods: The study design included determination of the proper antibiotic and probiotic strain combination and clinical application of probiotic strains. The control group consisted of 63 (48.46%) patients who underwent traditional multimodal treatment of peritonitis and the study group of 67 (51.54%) individuals, with inclusion of different antibiotic/probiotic combinations., Results: Results: Prior to antimicrobial therapy 67.7% patients of both groups' patients had severe dysbiosis, proving dysbiosis as a sign of peritonitis. S. boulardii showed widest resistance spectrum and was used for probiotic therapy in study group. Intestinal dysbiosis grades distribution in control group significantly worsened, while in study group ratio of severe dysbiosis significantly dropped from 58.2% to 38.8% with significant growth of grade II dysbiosis to 61.2%. No visible differences in disease course and clinical picture, duration or complications rate between study and control groups were observed., Conclusion: Conclusions: Most of probiotic strains lack antibacterial resistance that makes meaningless their use during systemic antibiotic therapy of acute peritonitis. It is characterized by harsh changes of intestinal microbiota (severe intestinal dysbiosis). While probiotic strains showed antibiotic tolerance, their use presented no significant clinical efficacy, though high level of positive influence on intestinal dysbiosis was observed.

Acute necrotic pancreatitis was followed by disorders of intestinal functions in 96.7% of patients and in 68% — its failure was occurred what had directly influenced on frequency of purulent—septic complication and mortality rate. It was proved that citrulline plasma level had been objectively reflected the severity of enteral failure and served as independent lethality criteria in patients with acute necrotic pancreatitis.

Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, was conducted. Content of presepsin, procalcitonin, С—reactive protein and interleukin—6 (ІL—6) in the patients' blood plasma was determined, and bacteriological investiga' tions, contrast—enhanced CT were conducted as well. Positive results of bacteriologi' cal investigations were noted in 43 patients. Level of presepsin and procalcitonin in patients, suffering purulent—septic complications, in 3 — 4 times exceeded such in a sterile pancreonecrosis. Presersin level,exceeding over 632 pg/ml, have permitted to confirm the presence of local and systemic infection with high specificity and sensitivi' ty, and this have exceeded diagnostic possibilities of the procalcitonin content determi' nation. High level of ІL—6 and С—reactive protein is characteristic for the systemic inflammatory response syndrome (SIRS) of infective and noninfective origin.

In 70 patients, suffering an acute necrotic pancreatitis (ANP), and 10 practically healthy persons a content of presepsin in a blood plasm, using immunochemiluminescent method and conducted bacteriological investigations, were analyzed. The infection occurrence is accompanied by plausible upgrading of a presepsin level in a blood plasm, depending on activity and severity of a septic process: in local infection--up to (677 ± 30) pg/ml, sepsis--up to (988 ± 47) pg/ml, severe sepsis--up to 2668 pg/ml; in an ANP without infection it have constituted (332 ± 38) pg/mI at average, in practically healthy persons--(184 ± 16) pg/mI. A presepsin level correlates with a state severity in accordance to APACHE I scale, what permits to estimate the patients state severity objectively, to prognosticate a favorable and unfavorable consequences of treatment, rapidly changing, depending on efficacy of treatment.

There were examined 113 patients, in whom an acute necrotic pancreatitis was diagnosed. While admittance to hospital a constant organ insufficiency was revealed in 50 (44%), a transient one--in 63 (56%) patients. In total 31 (27.4%) patients died. Respiratory insufficiency have occurred in 67% patients, and almost with similar rate--cardio-vascular (in 59%), renal (in 56%) and enteral (in 54%), dominating in the lethality structure. The BISAP (Bedcide Index for Severity in Acute Pancreatitis) scales applied permit with high probability to prognosticate the organ insufficiency and lethality in patients, suffering an acute necrotic pancreatitis.