Mkrtych Ogannisyan, Anton Slivin, Tyler W. LeBaron, Alex Tarnava, Valeriy Karmazin, Sergey Bazanovich, Vladislav Dolgachev, Anna Vychik, Alexander Strizhkov, Sergey Parastaev. JLM 2025;15:8-17. https://doi.org/10.15280/jlm.2025.15.1.8

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.

BACKGROUND: Chronic critical illness is characterized by ventilator dependence, systemic inflammatory response, multiorgan failure, secondary sarcopenia, hypermetabolism and hypercatabolism, and protein–energy malnutrition. In this category of intensive care unit patients, lower respiratory tract infections remain a significant cause of adverse outcomes, prolonged hospital stays, and increased treatment costs. It is impossible to provide adequate empirical treatment of lower respiratory tract infections without knowing the etiology and resistance of the leading pathogens of this nosocomial infection in a specific department of a healthcare organization. AIM: The study aimed to characterize the etiology of lower respiratory tract infections in intensive care unit patients from 2020 to 2023, determine their antibiotic susceptibility, identify the most common resistance mechanisms of leading pathogens, and provide recommendations for optimizing antimicrobial therapy. METHODS: The study included patients with confirmed lower respiratory tract infections, primarily those with prolonged or chronic critical illnesses, from 2020 to 2023. The BD Phoenix 100 automated analyzer was used to identify the pathogens. Susceptibility was interpreted using EUCAST criteria. RESULTS: From 2020 to 2023, the top 10 pathogens responsible for lower respiratory tract infections in 1,007 patients were predominantly gram-negative microorganisms. For this period, the following trends were noted: an increase in Acinetobacter baumannii from 13.22% to 21.40% (p 0.001), and a decrease in Escherichia coli from 7.90% to 2.98% (p 0.001). From 2020 to 2023, the resistance of Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems increased significantly, from 80.50% to 91.64% (p 0.001) and from 89.89% to 98.14% (p 0.001), respectively. Among carbapenemase-producing Klebsiella pneumoniae, resistance to colistin, tigecycline, and ceftazidime + avibactam increased from 4.95% to 9.00% (p 0.001), from 48.76% to 71.28% (p 0.001), and from 33.06% to 47.73% (p = 0.041), respectively. CONCLUSION: The predominant pathogens causing lower respiratory tract infections in intensive care unit patients included Gram-negative bacteria with a high level of antibiotic resistance. These bacteria included carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. The etiological structure of lower respiratory tract infections and their antibiotic susceptibility in these patients should be evaluated to create local protocols for effective empirical antimicrobial therapy in each specific intensive care unit of a healthcare organization.

Objective: to reveal the frequency of deviations occurrence in individual biochemical indicators, which can be markers of hidden metabolicconditioned deviations in the health of athletes.Materials and methods. Members of sports teams of Russia at the age of 16 to 38 years were examined. The total number of examined athletes was 5245: 3167 were male athletes and 2078 were female athletes. We studied 25 indicators of the biochemical composition of blood, showing latent metabolic disorders and the activity of its regulators, negative shifts in the functional state of individual physiological systems of the body and possible damage to tissues of individual organs.Results. Reference ranges and their centile gradations were calculated on the basis of a large array of data for 25 biochemical parameters. The use of centile gradations in assessing the values of blood biochemical parameters, recorded during the current monitoring in athletes, makes it possible to establish the vector of their changes and timely make changes in the volume and orientation of training loads, as well as to reasonably develop individualized programs for the athlete’s metabolic support. The use of the centile approach and the formation on its basis of gradation scales for each of the studied blood biochemical parameters also made it possible to establish the percentage of persons with significant deviations in certain biochemical parameters among the studied sample of athletes, admitted to the training process within the framework of in-depth medical examinations (DMO).Conclusion: such deviations from the norm may indicate hidden metabolic disorders that occur against the background of professional sports loads, and in the absence of timely compensation, they can lead to a breakdown in adaptation and the development of various metabolic-related pathologies

BACKGROUND: Bacteremia is a serious clinical condition that often precedes or accompanies sepsis and septic shock, which remain leading causes of hospital mortality worldwide. Understanding the epidemiology of bacteremia—including antimicrobial resistance patterns—and treatment principles is critical for improving outcomes in patients with chronic critical illness and severe brain injury. AIM: This study aimed to determine the profile of bacteremia in patients with severe brain injury in predominantly chronic critical illness admitted to intensive care units from 2018 to 2024 and their antibiotic susceptibility; to identify common resistance mechanisms of leading pathogens; and to formulate recommendations for optimizing antimicrobial therapy in this population. METHODS: The study included patients with severe brain injury in predominantly chronic critical illness who developed clinically significant bacteremia. Microorganisms were identified, and antibiotic susceptibility was determined using the BD Phoenix 100 automated analyzer. Susceptibility interpretation followed EUCAST criteria. RESULTS: Among 292 patients in predominantly chronic critical illness, the top ten bacteremia pathogens were primarily Gram-negative organisms, including Klebsiella pneumoniae (40.11%), Pseudomonas aeruginosa (6.22%), Proteus/ Providencia spp. (5.94%), Acinetobacter baumannii (5.37%), Serratia marcescens (4.24%), Escherichia coli (3.10%), and Enterobacter cloacae (1.69%). During this period, high carbapenem resistance was observed in Klebsiella pneumoniae (84.29%) and Pseudomonas aeruginosa (61.90%). Among Gram-positive organisms, coagulase-negative staphylococci predominated (21.47%). CONCLUSION: Gram-negative bacteria with high levels of antibiotic resistance, including carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa, were the predominant pathogens in bacteremia among patients with chronic critical illness in intensive care units. Establishing effective empirical antimicrobial therapy protocols requires analysis of local antibiotic susceptibility data.

In this study, we investigated von Willebrand factor (VWF)-related parameters in 30 patients with stable coronary artery disease (CAD) and 50 patients without CAD. In both groups, the following were measured: the VWF antigen level (VWF:Ag); the VWF ristocetin cofactor activity (VWF:RCo); the VWF collagen-binding activity (VWF:CB); and VWF-mediated platelet adhesion. Platelet adhesion was measured in whole blood at a shear rate of 1300 s⁻¹ using a microfluidic chamber with a collagen-coated surface. VWF:Ag and VWF:RCo were found to be the same in both groups of patients. However, VWF:CB was found to be lower in patients with CAD compared with patients without CAD, with values of 106.7% (82.1; 131.6) and 160.4% (112.5; 218.1), respectively (p < 0.001). The decrease in platelet adhesion after GPIb inhibition was more pronounced in patients with CAD compared with patients of the control group, with recorded values of 76.0% (60.6; 82.1) and 29.3% (0.0; 60.4), respectively (p < 0.001). After adjusting for traditional risk factors, the odds ratio for CAD was found to be 0.98 (95% CI, 0.97–0.99; p = 0.011) per 1% increase in VWF:CB activity, and 1.06 (95% CI, 1.03–1.09; p < 0.001) per 1% decrease in GPIb-mediated platelet adhesion. The findings presented in this paper indicate a possible critical role played by complex VWF–collagen-platelet interactions in the development of CAD.