Chronically critically ill patients are a rapidly growing population requiring long-term intensive care. Lower respiratory tract infections are the main infectious complications in these patients. Adaptive phage prophylaxis may be one of the perspective and insufficiently studied approaches for prevention of respiratory infectious complications in intensive care units. OBJECTIVE To study the effectiveness of complex cocktail complex drag of bacteriophages in prevention of infectious respiratory complications in chronically critically ill patients. MATERIAL AND METHODS The study included ICU patients at the Federal Research Clinical Center of Intensive Care and Rehabilitology. Overall sample consisted of 79 patients with severe brain damage. Group 1 (n=41) received complex drag of bacteriophages for prevention of pneumonia, group No. 2 (n=38) — standard therapy. All patients were followed-up for 28 days. RESULTS Both groups were comparable in gender, age and clinical severity. Microbiological examination revealed multidrug-resistant gram-negative bacteria (Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) in majority of patients. In the 1^st group, resistance genes were less common compared to the control group. Incidence of recurrent pneumonia was lower in the same group. CONCLUSION Prophylactic phage therapy can reduce the number of antimicrobial drugs. Incidence of nosocomial pneumonia recurrences after 14 and 21 days was lower in the main group.

The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach.

The study of circadian rhythms in the human body using temperature measurements is the most informative way to assess the viability of the body’s rhythm-organizing systems. Pathological processes can affect circadian rhythm dynamics in damaged organs. Severe brain damage that caused the development of disorders of consciousness (DOC) (strokes, traumatic brain injury) disrupts the activity of central oscillators, by directly damaging or destroying the periphery links, and the level of preservation of circadian rhythms and the dynamics of their recovery can be informative diagnostic criteria for patient’s condition assessment. This study examined 23 patients with DOC by using a non-invasive method for obtaining body and cerebral cortex temperature to compare with healthy controls. Measurements were made with a 4 h interval for 52 h beginning at 08:00 on day 1 and ending at 08:00 on day 3. The profile of patients with DOC showed complete disruption compared to healthy controls with rhythmic patterns. The results indicate that the mechanisms for maintaining brain circadian rhythms are different from general homeostasis regulation of the body. Use of microwave radio thermometry for the identification of rehabilitation potential in patients with DOC is a promising area of investigation.

Nowadays there is a growing interest worldwide in using bacteriophages for therapeutic purposes to combat antibiotic-resistant bacterial strains, driven by the increasing ineffectiveness of drugs against bacterial infections. Despite this fact, no novel commercially available therapeutic phage products have been developed in the last two decades, as it is extremely difficult to register them under the current legal regulations. This paper presents a description of the interaction between a bacteriophage manufacturer and a clinical institution, the specificity of which is the selection of bacteriophages not for an individual patient, but for the entire spectrum of bacteria circulating in the intensive care unit with continuous clinical and microbiological monitoring of efficacy. The study presents the description of three clinical cases of patients who received bacteriophage complex via inhalation for 28 days according to the protocol without antibiotic use throughout the period. No adverse effects were observed and the elimination of multidrug-resistant microorganisms from the bronchoalveolar lavage contents was detected in all patients. A decrease in such inflammatory markers as C-reactive protein (CRP) and procalcitonin was also noted. The obtained results demonstrate the potential of an adaptive phage therapy protocol in intensive care units for reducing the amount of antibiotics used and preserving their efficacy.

According to various data, sports traumatic brain injury (TBI) accounts for up to 20% of all injuries in athletes, and the number of cases of traumatization is progressively increasing year by year due to an increase in the number of people involved in sports, the growing popularity of extreme and contact sports, as well as a high level of motivation to achieve record results. The structure of sports TBI is dominated by mild TBI, which can provoke the development of a very wide range of complications and negative consequences that affect not only the result, but, most importantly, the quality of life of athletes. The pathogenesis of mild TBI has been studied, therapy and rehabilitation programs have been developed. At the same time, the features of sports TBI that significantly distinguish it from domestic, road or criminal injuries are not sufficiently taken into account: repeated frequent TBI, increased body and brain temperature, peripheral redistribution of blood flow and hypocapnia associated with physical exertion and significantly affecting cerebral blood flow. An athlete receives a TBI during the most vulnerable period for the brain. To a large extent, these features are associated with the high incidence of various kinds of neurological complications of sports TBI (cognitive disorders, memory impairment, sleep disorders, migraines, etc.). Special techniques that can prevent complications of sports TBI have not been developed. Brain injury is an independent cause of the development of cerebral hyperthermia, which significantly worsens the course and consequences of TBI. The well-known technology of craniocerebral hypothermia (CCG) allows to reduce physical general and cerebral hyperthermia, to increase the resistance of neurons of the cerebral cortex to hypoxia and trauma. However, this technology is used sporadically, which, apparently, is due to the lack of awareness of coaches and doctors of sports teams specializing in sports medicine and rehabilitation. The purpose of the review is to analyze the features of the action of selective hypothermia of the cerebral cortex, used to prevent complications of mild sports TBI.

Introduction. Sepsis in patients with prolonged or chronic critical illness is associated with a high mortality and prolonged exposure to antimicrobial therapy. However, data on the microbiological profile and trends in antimicrobial resistance in this population remain limited. Objective. To assess the microbiological profile, antimicrobial consumption, and dynamics of antimicrobial resistance in patients with sepsis who experienced prolonged stays in intensive care units (ICUs). Materials and methods. We performed an analysis of the Russian Intensive Care Dataset (RICD v2.0, FNCC RR, 2017–2024). The study included patients with confirmed sepsis according to Sepsis-3 criteria who remained in the ICU for ≥24 hours. Data on microbiological testing, antimicrobial prescriptions, and resistance patterns were extracted. Antimicrobial consumption was quantified using standardized units of DDD per 100 bed-days. Integrated resistance was assessed using the Drug Resistance Index (DRI). Results. A total of 336 patients were included (median age 64 years; male – 43.5 %, median ICU stay 44 days). The leading causative pathogens were Klebsiella pneumoniae and Pseudomonas aeruginosa. Between 2022 and 2024, consumption of aminoglycosides, cephalosporins, cotrimoxazole, linezolid, and tigecycline increased, while use of carbapenems, levofloxacin, and metronidazole declined. Resistance to ceftazidime-avibactam rose from 37 % to 87 % (p=0.004), whereas resistance rates decreased for tigecycline, vancomycin, and gentamicin (p<0.01). The overall DRI reached 32.6 % in 2022, 41.2 % in 2023, and 34.1 % in 2024. Conclusions. This study demonstrates persistently high levels of antimicrobial resistance among septic patients with prolonged ICU stays, with a predominance of Gram-negative pathogens in the etiological structure of infections. Every third empirical prescription of antibiotic therapy was accompanied by resistance of the infectious agent. These findings highlight the need for continuous microbiological surveillance, optimization of antimicrobial stewardship programs.