Urinary tract infections (UTIs) are among the most common bacterial infections in clinical practice. The aim of the RESOURCE study was to determine the antimicrobial resistance profile of gram-negative bacteria isolated from outpatient urine samples collected across the Russian Federation. A total of 96,781 urine samples were collected from 520 cities of the Russian Federation between January 1 and December 31, 2017. Antibiotic susceptibility was performed using semi-automated analysers. The mean age of the study population was 40.9 years, 80.2% were female and 19.8% were male. Of the uropathogens isolated, 64.2% were gram-negative bacteria. Among these, Escherichia coli was the most common (49.1%), followed by Klebsiella pneumoniae (9.5%), Proteus mirabilis (2.9%), Pseudomonas aeruginosa (1.7%) and Enterobacter spp. (1.0%). Of the antibiotics tested, 50% of the isolated E. coli strains were resistant to ampicillin, followed by co-trimoxazole (30.3%), aztreonam (26.2%), levofloxacin (28.8%) and cefuroxime (21%). Conversely, E. coli were highly susceptible to imipenem (0.7% resistant strains isolated), amikacin (0.9%), nitrofurantoin (4.5%) and fosfomycin (1.2%). The most active antimicrobials against K. pneumoniae were imipenem (6.8% resistant strains) and colistin (0.5%), while piperacillin/tazobactam (4.2%), cefoperazone/sulbactam (3.1%) and imipenem (0%) were the most active agents against P. mirabilis. The antimicrobials showing the highest activity against P. aeruginosa were colistin (10.7% resistant strains) and aztreonam (0%), while piperacillin/tazobactam (7.1%) and cefoperazone/sulbactam (2.3%) showed the highest activity against Enterobacter spp. The prevalence of fluoroquinolone and cephalosporin resistance among common UTI-causing gram-negative bacteria highlights the growing challenge of successfully treating community-onsetUTIs.

ЦЕЛЬ Обновленных клинических рекомендаций состоит в представлении специалистам, в первую очередь анестезиологам-реаниматологам, современных, основанных на методах доказательной медицины данных по этиологии, эпидемиологии, способах диагностики, лечения и профилактики тяжелой внебольничной пневмонии у взрослых. При подготовке настоящего документа использованы и адаптированы научные исследования высокого уровня доказательности, систематические обзоры и метаанализы, рекомендации Американского общества инфекционных заболеваний/Американского торакального общества (IDSA/ATS), Европейского респираторного общества/Европейского общества интенсивной терапии/Европейского общества клинической микробиологии и инфекционным заболеваниям/Латиноамериканского торакального общества (ERS/ESICM/ESCMID/ALAT) и прочих ведущих профессиональных сообществ. Подробно представлены современные рекомендации по дифференцированной антибиотикотерапии пациентов с тяжелой внебольничной пневмонией (ТВП) в зависимости от наличия у них факторов риска инфицирования определенными микроорганизмами, приведены схемы этиотропной терапии при установленном возбудителе. Значительный раздел рекомендаций посвящен респираторной терапии при ТВП, сформулирован ступенчатый алгоритм лечения острой дыхательной недостаточности в зависимости от ее стадии. Детально охарактеризованы наиболее эффективные и безопасные режимы инвазивных и неинвазивных способов респираторной поддержки. В качестве методов адъювантной терапии названы глюкокортикостероиды при невозможности стабилизировать показатели гемодинамики на фоне адекватной гидратации и вазопрессорной поддержки, а также парентеральные антикоагулянты с целью предупреждения тромбоэмболических осложнений. Для профилактики ТВП у пациентов высокого риска предложены антипневмококковые и противогриппозные вакцины. Представлены критерии оценки качества медицинской помощи.

The resistance of Enterobacterales to carbapenems can be realized by different mechanisms, but the most common one is enzymatic, associated with the production of carbapenemases. Carbapenemases of enterobacteria are characterized by a wide variety;they are represented in three classes of beta-lactamases. The most well-known carbapenemases belong to classes A (KPC, GESenzymes), D (OXA-48), and B (metalloenzymes — NDM, VIM, IMP). Detailed clinical and microbiological characteristics of carbapenemases are given, as well as recommendations for their detection. Carbapenemases are widespread, and the paper discusses the geographical distribution of carbapenemases in different regions of the world; OXA-48 and NDM are the most widelydistributed enzymes in Russia. The clinical significance of carbapenemases and risk factors for these infections are discussed,including the following: 1) previous carbapenem therapy; 2) high levels of carbapenemases in the Department; 3) colonization of theintestine with carbapenemase-producing enterobacteria; 4) traveling to regions with a high prevalence of carbapenemases (4th and5th epidemiological levels). The possibilities of antibacterial therapy of infections caused by carbapenem-resistant enterobacteriaare discussed, the clinical and pharmacological characteristics of different antibiotics (ceftazidime/avibactam, aztreonam, carbapenems, polymyxins, tigecycline, fosfomycin), their effectiveness and treatment options are analyzed in detail. Current clinicaldata showing the effectiveness of ceftazidime/avibactam monotherapy for infections caused by carbapenemase producers OXA-48and KPC are presented. Practical issues of management of such patients are discussed. Algorithms for empirical and targeted therapy of infections caused by carbapenem-resistant enterobacteria are presented.

Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread in most regions of the world, including Russia. This naturally affects both the effectiveness of antimicrobial therapy and the tactics of its use not only in adults but also in children. The coronavirus pandemic has highlighted the growing problems with the treatment of invasive mycoses, the selection of dosage of antibacterial agents when using sorption and dialysis therapy methods. In combination with the registration of new antibacterial drugs ABSTRACT in Russia, this necessitated the need to make adjustments to the Methodological recommendations “Diagnostics and Antimicrobial Therapy of Infections Caused by Polyresistant Strains of Microorganisms” (2nd edition), prepared by a group of leading Russian experts in 2022 [1]. The presented version was approved in December 2024 at a joint meeting of representatives of public organizations: the Russian Association of Anesthesiologists-Intensivists, the Interregional public organization “Alliance of Clinical Chemotherapists and Microbiologists”, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), the public organization “Russian Sepsis Forum”. These recommendations reflect the interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by polyresistant microorganisms.

Clinical guidelines «Sepsis (in adults)» are an interdisciplinary document developed by 8 professional non-profit public organizations and approved by the Scientific and Practical Council of the Ministry of Health of Russia. They are intended to help doctors of various specialties (anesthesiologist and intensivist, surgeon, emergency physician, neurosurgeon, cardiovascular surgeon, thoracic surgeon, transfusiologist, orthopedic traumatologist, nephrologist, urologist, maxillofacial surgeon, infectious disease physician, clinical pharmacologist, medical microbiologist) in determining the treatment strategy and tactics for patients with sepsis or at risk of its development. The material presented to the reader’s attention reflects the main provisions of the document that are important for practical work. Its full content can be found on the websites of the Ministry of Health (https://cr.minzdrav.gov. ru/) and the public organizations (in particular, https://association-ar.ru/; https://общество-хирургов.рф/; https://sepsisforum.ru/; https://www. antibiotic.ru/) that developed them. In terms of their main provisions, the recommendations correspond to the latest international guidelines (Surviving sepsis campaign from 2021), but take into account the specifics of the work of medical organizations in the Russian Federation. These recommendations apply to the following codes of the International statistical classification of diseases and problems related to adult health: A40 – streptococcal sepsis (A40.0/A40.1/A40.2/A40.3/A40.8/A40.9); A41 – other sepsis (A41.0/A41.1/A41.2/A41.3/A41.4/A41.5/A41.8/41.9) and B37.7 – candidal septicemia.