We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was < 2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited.

Objective. To study in vitro activity of antimicrobials against clinical isolates obtained from patients with community-acquired urinary tract infections (UTIs) in various regions of Russia in 2023. Materials and Methods. The study included 1098 isolates obtained from the urine of children and adults of both sexes of all age groups with acute and exacerbation of recurrent community-acquired UTIs, including pregnant women with asymptomatic bacteriuria. Isolates were collected in 29 centers in 21 cities of Russia in 2023 as part of a multicenter prospective epidemiological study of the dynamics of antibiotic resistance of pathogens causing community-acquired UTIs in different subsets of patients («DARMIS-2023»). The categories of susceptibility of isolates to antimicrobial drugs were based on the breakpoint values of minimum inhibitory concentrations (MIC) in accordance with the Russian recommendations «Determination of susceptibility of microorganisms to antimicrobial drugs» (Version 2024-02) and the updated EUCAST criteria (v. 14.0, 2024). Results. Enterobacterales accounted for a total of 88.1% of all isolated bacterial pathogens (89.6% in the adult subpopulation; 82.8% in the pregnant subpopulation and 89.6% in the subpopulation of children and adolescents under 18 years of age). The most prevalent species were Escherichia coli (72.2% in the adult subpopulation; 72.8% in the pregnant women subpopulation and 68.9% in the children and adolescents under 18 years of age subpopulation) and Klebsiella pneumoniae (10.8% in the adult subpopulation; 4.8% in the pregnant women subpopulation and 9.8% in the children and adolescents under 18 years of age subpopulation). Of the oral drugs, the minimal resistance in E. coli was demonstrated for nitrofurantoin (0.4% of isolates in the adult subpopulation; 0.0% in the pregnant women subpopulation and 1.6% in the children and adolescents under 18 years of age subpopulation) and fosfomycin (9.6% of isolates in the adult subpopulation; 4.4% in the pregnant women subpopulation and 1.6% in the children and adolescents under 18 years of age subpopulation). Of the parenteral agents, meropenem and amikacin had the highest activity: 0.8% and 1.0% resistant E. coli in the adult subpopulation; no resistant E. coli in the pregnant subpopulation; 0.0% and 0.8% in the children and adolescents under 18 years of age subpopulation, respectively. For each patient subpopulation, antimicrobial resistance of E. coli to ampicillin, amoxicillin/clavulanic acid, cefotaxime, cefixime, and trimethoprim-sulfamethoxazole was more than 20%. Rates of E. coli resistance to ciprofloxacin were 36.7% in the adult subpopulation; 22.1% in the pregnant subpopulation; and 22.2% in the children and adolescents under 18 years of age subpopulation. The rate of extended-spectrum beta-lactamase production based on phenotypic test results was 29.6% in the adult subpopulation; 23.6% in the pregnant subpopulation and 33.3% in the children and adolescents under 18 years of age subpopulation. Conclusions. In community-acquired UTIs the main clinical problem is the persistent high rate of E. coli resistance to cephalosporins, fluoroquinolones, aminopenicillins/beta-lactamase inhibitors, as well as the increase of the extended-spectrum beta-lactamases production. Remaining high in vitro activity of fosfomycin and nitrofurans allows to consider them as drugs of choice in uncomplicated lower urinary tract infections.

COVID-19 has had a significant impact on health care systems, including drug use. The present study aimed to evaluate the patterns of community supply of antimicrobials from community pharmacies during the COVID-19 pandemic in five cities of Russia. In a cross-sectional study, a random sample of pharmacies reported all episodes of antimicrobials supply during a one-week period. Patterns of supply (age and gender of customer, drug name and formulation, prescription availability, indication, etc.) were analyzed. Altogether, 71 pharmacies took part in the study and 5270 encounters were recorded. In total, 4.2% of visits resulted in supply of more than one antimicrobial agent and 5.2% were for parenteral formulations. The rate of prescription-based purchase in participated cities varied from 40.5 to 99.1%. Systemic antibiotics and antivirals accounted for the majority of supplies (60.5 and 26.3%, respectively). Upper respiratory tract infections were reported as the indication for antimicrobials usage in 36.9% of cases, followed by skin and soft tissue infections (12.1%) and urinary tract infections (8.7%); COVID-19 accounted for 8.4% of all supplies. Amoxicillin with clavulanic acid, azithromycin and amoxicillin were indicated as the top three antimicrobials purchased for upper respiratory tract infections, and azithromycin, umifenovir and levofloxacin were the top three for COVID-19. In general, a high rate of drugs dispensing without prescription was revealed. Antibiotics for systemic use remained the most common antimicrobials, whereas presumably viral upper respiratory tract infections were the main reason for their purchase. COVID-19 infection itself was responsible for a small proportion of the supply of antimicrobial agents, but systemic antibiotics accounted for more than a half of supplies.

Background. The inappropriate and overuse of antimicrobials is a problem worldwide. To target future interventions, a thorough understanding of current behavior reasons is needed. The aim of the study was to explore antibiotic knowledge, attitudes, and behaviors among patients residing in Russia. Methods. In total, 149 semistructured interviews were carried out with respondents using antibiotics without prescriptions. Interviews were used to assess participants practices to treat symptoms of a confirmed/suspected infectious disease and their behaviors, knowledge, and attitudes toward the use of antimicrobials. A directed content analysis was applied. Results. Despite regulation, inappropriate use of antibiotics is a common practice. Knowledge on the mechanism of action and indications for the use of antibiotics was generally low. However, self-diagnosis, self-treatment with antimicrobials, and attempts to purchase antibiotics in pharmacies with no prescription were quite common. Family members and friends were involved in decisions about treatment strategy. Time spent for the doctors visit, fear to be exposed to additional infections in outpatient clinics/hospitals, previous experience with antimicrobial self-treatment, and loyal policy of selling antibiotics influenced the respondents decisions of not going to the doctor. COVID-19 made an impact on antimicrobial self-treatment: there was a substantial complexity in contacting a medical healthcare provider. Most of the respondents did not pay much attention or even noticed informational materials on the proper use of antibiotics. Conclusion. Self-treatment with antibiotics in Russia exists. Conducted information campaigns were not effective enough as the low level of knowledge about antimicrobials and antimicrobial resistance was revealed by the present study.

Objectives: The study aimed to investigate behaviour, knowledge and practices towards antibiotic (AB) use among patients who purchased ABs with a prescription across Russia. Methods: Semi-structured interviews conducted in all eight Federal Districts, Moscow and Saint Petersburg in 2022 by 21 researchers trained specifically for this study. Data were analysed using a directed content analysis approach. Results: In total, 151 respondents were interviewed. Respiratory symptoms were the most common reason for AB prescription. The majority of patients discussed their complaints with family members or friends before consulting the physician and occasionally looked for information on antimicrobial treatment on the internet. The decision to use an AB was usually made by the physician, although patients often anticipated its prescription. Respondents typically chose to go to the nearest drug store to pick up the medicines, not seeking any recommendation from the local pharmacists. The level of knowledge about the effects of ABs was generally low. In most cases, patients were not aware of antimicrobial resistance and rarely recalled any information campaigns targeting prudent AB use. Respondents admitted COVID-19 had an impact on their behaviour: they have become more caring towards their health, but less likely to seek medical care because of the risk of infection. Conclusions: Our findings, in particular low awareness of the population about the effects of ABs and antimicrobial resistance, peculiarities of attitudes and behaviour (significant influence of the environment, tendency to self-diagnose, fairly high level of trust in doctors etc.) can be useful for the development of effective initiatives aiming for prudent AB use.