Currently, the issues of antimicrobial therapy and antimicrobial resistance are key both for medicine and for healthcare in general for a number of fundamental rea­sons pertaining not only to the health sector but also to social, economic, and even political spheres. The problem of antimicrobial resistance requires immediate and coordinated global action. This interview discusses the main strategies to ensure rational antimicrobial therapy and manage the associated risks in the current clinical setting with Roman S. Kozlov, Honoured Scientist of the Russian Federation, Rector of Smolensk State Medical University, Chief External Expert in Clinical Microbiology and Antimicrobial Resistance of the Ministry of Health of the Russian Federation, Head of the World Health Organisation Collaborating Centre for Capacity Building on Antimicrobial Resistance Surveillance and Research, Corresponding Member of the Russian Academy of Sciences, and Doctor of Medical Sciences.

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.

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.

Objective. To study the antimicrobial susceptibility profile of Moraxella catarrhalis isolates from different regions of Russia in 2010–2021. Materials and Methods. The study included 352 isolates of M. catarrhalis isolated in 11 cities of Russia (Volgograd, Irkutsk, Kazan, Kirov, Moscow, Murmansk, Perm, Seversk, Togliatti, Tomsk, and Ulan-Ude) in 2010–2021. Identification was done by MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing was determined by broth microdilution method in accordance with the ISO 20776-1:2020. Interpretation of results was done in accordance with EUCAST guidelines (v.14.0). Results. Most of the isolates were isolated from respiratory specimens: 225 (63.9%) from sputum, 49 (13.9%) from nasal swabs, 41 (11.6%) from sinus aspirates, 17 (4.8%) from bronchoalveolar lavage, 8 (2.3%) from middle ear fluid, 6 (1.7%) from pharyngeal swabs, and 5 (1.4%) from conjunctival secretions. All tested isolates were susceptible to beta-lactams for which interpretive criteria have been established (amoxicillin-clavulanate, cefixime, ceftriaxone, cefuroxime). The susceptibility to clarithromycin and azithromycin was 99.7% and 100%, respectively. Ciprofloxacin, levofloxacin and moxifloxacin were active against 98.9%, 99.2% and 99.7% of isolates tested, respectively. Susceptibility to tetracycline was 99.7% and to trimethoprim-sulfamethoxazole was 99.4% (92% of isolates susceptible, 7.4% – susceptible at increased exposure). Conclusions. In the Russian Federation there is a favorable situation regarding the susceptibility of M. catarrhalis to antimicrobials. Amoxicillin-clavulanic acid, cefixime, ceftriaxone, azithromycin, clarithromycin, ciprofloxacin, levofloxacin, moxifloxacin and tetracycline retain high in vitro activity

Piperacillin/tazobactam is a well-known β-lactam antibiotic that has been used in clinical practice since 1993. The review presents the clinical and pharmacological characteristics of piperacillin-tazobactam, the results of clinical studies and determines place of this antibiotic in the treatment of patients with severe urinary tract infections and intraabdominal infections in the light of current data of pathogens’ susceptibility in the Russian Federation and current clinical guidelines.

Objective. To determine spectrum and prevalence of genetic determinants of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patient in dermatovenerology clinics of two Russian megalopolises: Moscow and St. Petersburg in 2021–2024. Materials and Methods. A total of 530 M. genitalium DNA-positive specimens (urethral and cervical swabs) obtained from men and women from the STD clinic in St. Petersburg and Сlinical facilities of the Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology of the Moscow Department of Health Care were analyzed. Screening in local laboratories was performed using commercially available kits for isolation and detection of M. genitalium DNA. Primary screening for resistance-associated mutations was carried out using the previously developed protocol of PCR-RT (allows detecting any nucleotide substitutions in the 23S rRNA gene and parC gene) [1]. The results were confirmed using Sanger sequencing [2]. The study results are presented as an open project on the AMRcloud platform (https://amrcloud.net/ru/project/demares/). Results. 185 and 345 M. genitalium-positive samples from St. Petersburg and Moscow, respectively, showed the presence of a specific signal in both the 23S rRNA gene and parC gene in primary screening. The macrolide-resistance mutations was in 29% (54/185) of samples from St. Petersburg and in 28% (97/345) from Moscow, with a predominance of the A2059G 23S rRNA genotype of M. genitalium in 57% (31/54) and 68% (66/97), respectively. The second largest proportion were samples in which the nucleotide substitution A→G at position 2058 was detected: 23/54 (42%) from St. Petersburg and 30/97 (30%) from Moscow. Mutations to fluoroquinolones were detected in the parC gene in 47/185 (25%) and 73/345 (21%) samples from St. Petersburg and Moscow, respectively. In Moscow, the amino acid substitution S80I prevails 39% (29/73), the second most abundant D84N occured in 35% (26/73), in St. Petersburg, the similar ratio of S80I was 44% (21/47), D84N was 29% (14/47). In Moscow, seven samples carried the third most common mutation S80N, which is 9%, in St. Petersburg this figure, was twice as high – 19% (9/47). The share of other mutations in the two cities was not more than 1% (D84G, D84Y and S81P). In St. Petersburg, simultaneously with mutations in 23S rRNA, the presence of amino acid substitutions in the ParC QRDR was also confirmed, which represented a case of combined resistance to both groups antibiotics; this level was 1.5 times higher than in Moscow (40% (39/97)) and amounted to 61% (33/54). The most common combination of mutations was A2059G (23S rRNA) + S80I (parC), which made up to 33% (18/54) in St. Petersburg and 25.7% (25/97) in Moscow. The second most abundant genotype – A2058G (23S rRNA) + D84N (parC) accounted for 14% (8/54) and 10% (10/97), respectively. Conclusions. The high level of resistance to macrolides and fluoroquinolones in M. genitalium in two major Russian cities is a significant problem and need for comprehensive resistance testing before prescribing therapy and surveillance programs. The introduction of adapted diagnostic and therapeutic algorithms will reduce the duration of drug administration, increase the effectiveness of therapy and reduce the burden on the health care system. The use of long-term monitoring will improve the policy of antibiotic prescription and reduce the growth of antimicrobial resistance and its spread in Russia.

The growth and spread of antimicrobial resistance (AMR) is one of the main threats to the healthcare system. Currently, along with the development of new antimicrobial drugs (AMPs) the basic approach to countering the spread of AMR is the rational use of existing medicines. Selection of the optimal drug taking into account its activity, doses, frequency and route of administration are the basis of rational antimicrobial therapy. However, due to widespread availability of AMR, availability of up-to-date information on activity of AMP is extremely important. Therefore, monitoring of antibiotic resistance is a key activity to ensure providing the evidence base on which antimicrobial formularies should be drawn up drugs and treatment protocols. In the solution of these problems in the Russian Federation active role plaies the Methodological Verification Center on Antimicrobial Resistance – Reference center for clinical pharmacology, created on the basis of the Research Institute of Antimicrobial Chemotherapy of the Smolensk State Medical University of the Ministry of Health of Russian Federation.

Сeftaroline fosamil is a fifth-generation cephalosporin and a unique β-lactam and the only currently registered in the Russian Federation cephalosporin with activity against MRSA. Сeftaroline is approved for use in pediatric practice for the treatment of children with community-acquired pneumonia and complicated skin and soft tissue infections, including cases of patients with concomitant bacteremia. The place of ceftaroline in the treatment of severe and life-threatening infections in children is primarily due to its high activity against the key causative agents of community-acquired pneumonia and skin and soft tissue infections (first of all, S. pneumoniae and S. aureus, including MRSA), bactericidal mechanism of action, creation of effective concentrations and penetration into the infection’s site, low potential for resistance development, proven significant development of clinical effect, high clinical efficacy in these infections and favorable tolerability and safety profile. The review presents the results of the program of clinical evaluation of ceftaroline in children, analyzes current data on etiology and antimicrobial resistance of the key pathogens of community-acquired pneumonia and skin and soft tissue infections in the Russian Federation, defines the place of ceftaroline in clinical recommendations in children, and characterizes the patient’s profile to whom the prescription of ceftaroline in hospital is indicated.

Objective. To study the prevalence and mechanisms of antibiotic resistance, including carbapenemase production, in clinical isolates of Klebsiella pneumoniae and Escherichia coli isolated in different regions of Russia as part of the sentinel multicenter surveillance study in 2020–2021, and to explore the population structure of K. pneumoniae and the impact of “high-risk clones” on antibiotic resistance. Materials and Methods. Consecutive, non-duplicate isolates of K. pneumoniae (n = 2503) and E. coli (n = 2055) isolated from various specimens (blood, cerebrospinal fluid, respiratory samples, urine, wound secretions, etc.) of hospitalized patients with clinical signs of infection in 55 hospitals of 29 cities of Russia were studied. Species identification of isolates was performed by matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antibiotic susceptibilities were determined by serial broth microdilution or, in the case of fosfomycin, by agar dilution method, and results were interpreted according to EUCAST v13 MIC breakpoints. Carbapenemase production was determined phenotypically by carbapenem inactivation method (CIM), the presence of genes of the most common serine carbapenemases (KPC, OXA-48) and metallo-β-lactamases (VIM, IMP, NDM) was determined by real-time PCR. K. pneumoniae clinical isolates were genotyped and assigned to the known clonal complexes (CC) and sequence types (ST) using SNP typing and multilocus sequencing typing (MLST) methods. K- and O-serotypes, acquired resistance and virulence genes, and plasmids carrying these genes were characterized using whole-genome sequencing of selected isolates (n = 215). Results. The resistance rates of nosocomial/community-acquired isolates of K. pneumoniae were as follows: amoxicillin-clavulanate – 88.63⁄57.99%, piperacillin-tazobactam – 82.92⁄45.49%, cefotaxime – 87.74⁄56.97%, ceftazidime – 84.76⁄53.07%, cefepime – 81.43⁄49.18%, aztreonam – 1.63⁄53.28%, ceftazidime-avibactam – 30, 88⁄9.22%, ceftolozan-tazobactam – 70.06/31.35%, ertapenem – 72.10⁄28.69%, meropenem – 49.60⁄15.16%, imipenem – 44.54⁄13.73%, gentamicin – 60.82⁄30.33%, amikacin – 42.06/17.21%, ciprofloxacin – 85.10⁄49.39%; trimethoprimsulfamethoxazole – 74.38⁄48.16%, colistin – 5.96⁄2.25%. The resistance of nosocomial/outpatient isolates of E. coli were: ampicillin – 84.93⁄67.67%, amoxicillin-clavulanate – 57.37⁄39.73%, piperacillin-tazobactam – 19.48⁄8.70%, cefotaxime – 63.83⁄34.19%, ceftazidime – 45.32⁄20.34%, cefepime – 35.95⁄16.61%, aztreonam – 51.78⁄26.11%, ceftazidime-avibactam – 5.71⁄0.80%, ceftolozane-tazobactam – 11, 95⁄2.22%, ertapenem – 8.18⁄1.42%, meropenem – 5.17⁄0.53%, imipenem – 4.95⁄0.36%, gentamicin – 24.54⁄13.68%, amikacin – 5.49⁄1.42%, ciprofloxacin – 54, 14⁄32.50%, trimethoprim-sulfamethoxazole – 52.21⁄38.54%, fosfomycin – 2.48⁄1.43%, colistin – 1.60⁄1.07%, tigecycline – 6.35⁄3.11%. The frequency of carbapenemase production among K. pneumoniae nosocomial isolates was 65.32% (OXA-48 – 40.75%, NDM – 30.28%, KPC – 8.74%, OXA-48 + NDM – 10.62%, OXA-48 + KPC – 2.98%, NDM + KPC – 0.45%, OXA-48 + NDM + KPC – 0.20%). More than 70% of nosocomial isolates of K. pneumoniae belonged to only 7 major genetic lineages known as “high-risk international clones”: CC395 – 37.40%, CC23 – 9.59%, CC307 – 8.64%, CC147 – 7.61%, CC15 – 2.95%, CC258 – 2.92%, and CC11 – 2.41%. The population of community-acquired K. pneumoniae was characterized by significantly greater genetic diversity (Simpson diversity index: D = 0.919; 95% CI: 0.904 to 0.933) compared with the population of nosocomial strains (Simpson diversity index: D = 0.815; 95% CI: 0.802 to 0.827). Strains of the “hypervirulent” genetic lineage of K. pneumoniae CC23 were more common in community-acquired infections. Conclusions. The extremely high frequency of resistance to cephalosporins in K. pneumoniae (> 80%) and E. coli (> 60%), as well as the high frequency of combined resistance to aminoglycosides and fluoroquinolones precludes their empirical use for the treatment of serious nosocomial infections caused by these pathogens. K. pneumoniae shows a rapid increase in resistance to carbapenems, mainly due to the spread of carbapenemases of three major groups: OXA-48, NDM and KPC. The overall increase in the frequency of carbapenemase production is accompanied by the growing diversity of carbapenemases, the increasing prevalence of strains producing NDM and KPC enzymes and those co-producing multiple carbapenemases simultaneously. In community-acquired infections, the high prevalence of resistance to cephalosporins in E. coli (> 30%) and K. pneumoniae (> 50%) remains the most important problem.

Objective. To evaluate in vitro activity of various macrolide antibiotics against a current collection of clinical isolates of Streptococcus pneumoniae and Streptococcus pyogenes isolated from patients with community-acquired infections in different regions of the Russian Federation. Materials and Methods. A total of 350 clinical isolates from patients with community-acquired infections, including 200 S. pneumoniae and 150 S. pyogenes, were included in the study. To further evaluate the in vitro activity of 16-member macrolides against erythromycin-resistant isolates (MIC ≥ 0.5 mg/L), a retrospective collection of 253 erythromycin-resistant S. pneumoniae and 112 S. pyogenes isolates was tested. Susceptibility to antimicrobials was determined by broth microdilution method in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST, v.14.0). Results. Resistant to 14- and 15-member macrolides erythromycin, clarithromycin, and azithromycin were 41.5%, 42% and 40.5% of S. pneumoniae isolates (MIC50/MIC90 values were 0.06/128, 0.03/128, and 0.125/128 mg/L, respectively). MIC50/MIC90 values for spiramycin and josamycin were 0.06/128 mg/L and 25/32 mg/L, respectively. When the previously used 1996 French Society for Microbiology (SFM) criteria (Ch, ≤ 1 mg/L; P, > 4 mg/L) were applied, 70.5% of S. pneumoniae isolates could be considered as susceptible to spiramycin. MIC value ≥0.5 mg/L accounted for 31.5% of isolates for spiramycin and 48% for josamycin. Among the retrospective collection of erythromycin-resistant S. pneumoniae isolates, 64.0% of isolates could be considered as resistant to spiramycin using the old SFM interpretative criteria; 74.9% of isolates had spiramycin MIC ≥ 0.5 mg/L. Among the S. pyogenes isolates, 19.3%, 22%, and 26.7% were resistant to the 14- and 15-member macrolides erythromycin, clarithromycin, and azithromycin (MIC50/MIC90 0.03/1, 0.03/2, and 0.06/8 mg/L, respectively). MIC50/MIC90 values for the 16-member macrolides spiramycin and josamycin were 0.25/0.5 mg/L and 0.125/0.5 mg/L, respectively. When the 1996 SFM criteria (S – ≤ 1 mg/L; R – > 4 mg/L) were applied, 94.7% of S. pyogenes isolates could be considered as susceptible to spiramycin; MIC values ≥ 0.5 mg/L had 15.3% of isolates for spiramycin and 16.5% for josamycin. Conclusions. The 16-member macrolide spiramycin can retain in vitro activity against a significant proportion of S. pneumoniae and S. pyogenes isolates resistant to 14- and 15-member macrolides, which should be taken into account when choosing therapy for infections caused by these microorganisms.

Bronchiectasis, ICD-10 – J47, (BE) is a chronic respiratory disease characterized clinically by cough, sputum production and bronchial infection, and radiographically by abnormal and persistent dilation of the bronchi. Common causes include cystic fibrosis, primary ciliary dyskinesia, immune disorders, systemic inflammatory diseases and infections, and other factors. However, some cases are idiopathic, when the cause cannot be identified. In practice, patients with bronchiectasis are divided into two groups: associated and not associated with cystic fibrosis. The prevalence of the disease varies significantly worldwide; it is not reliably known in the Russian Federation.The aim of the review is to analyze the literature data on modern approaches to the diagnosis of BE and to familiarize readers with diagnostic methods and basic approaches to the treatment.Methods. Data from 77 articles and the expert opinion of specialists providing care to patients with BE were used.Results. The main causes, frequency of occurrence, clinical phenotypes and treatment approaches for BE are described. There are many clinical, laboratory, instrumental and radiological features that provide insight into the etiology of BE. The European consensus is that the goal of treating BE is to restore or maintain normal lung function. There are no randomized trials on the treatment of BE, so all treatment guidelines are based on very low-level evidence or extrapolated from cystic fibrosis guidelines. Recommendations for mucolytic, antibacterial and anti-inflammatory therapy for BE are described, taking into account international and national experience.Conclusion. The development of a new version of clinical guidelines with modern relevant information will improve the diagnosis and treatment of BE in the Russian Federation.

Breast surgery is a broad field that includes both surgical treatment of breast diseases and various variants of reconstructive and plastic surgeries for breast correction. Despite the fact that according to the accepted classification breast interventions are considered to be «clean», the incidence of infectious complications in surgical treatment of breast cancer is higher than in conventional «clean» surgical interventions, and the rate increases significantly in case of one-stage breast reconstruction with expanders or implants. In these practical guidelines for the first time in Russia a detailed analysis of the available current publications on antibiotic prophylaxis and treatment of infectious complications (surgical site infections and implantassociated infections) is presented and specific schemes of antibiotic use in breast surgery for both breast cancer and reconstructive-plastic surgeries are proposed.

Objective. To evaluate prescribing patterns of antimicrobials and quantify them in relation to quality indicators in Russian multi-field hospitals. Materials and Methods. Point Prevalence Survey of Antimicrobial Consumption as a part of an international Global-PPS project was conducted in 8 multi-field hospitals in different Russian cities (Krasnoyarsk, Moscow, Omsk, Saratov, Smolensk, Ulan-Ude, Yakutsk) during the period from May till December 2021. Case records of patients who received therapeutic or prophylactic systemic antimicrobial agents were analyzed. Local practices of antimicrobials’ utilization were evaluated in relation to quality indicators defined by the study protocol. Results. Common mistakes requiring a prompt intervention included low adherence to clinical guidelines, absence of stop/review dates in the medical records, extended duration of surgical prophylaxis, III generation cephalosporin’s overuse and low rate of targeted therapy. Conclusions. The results of the project can be valuable for the improvement to antimicrobial utilization approaches at the study centers as well as for monitoring of antimicrobial stewardship programs’ implementation.

It has been proven that the SARS-CoV-2 virus is able to initiate the development of a number of metabolic disorders, leading to diabetes mellitus (DM). Given the high frequency of cases of newly diagnosed type 1 diabetes in children, as well as possible adverse prospective consequences, the study of such clinical cases seems to us to be an extremely relevant practice for doctors of all specialties. The aim of the study was to to demonstrate of a clinical case of newly diagnosed type 1 diabetes in a child with COVID-19. The article presents a general understanding of the pathogenetically bidirectional relationship between a new coronavirus infection and diabetes mellitus, presents a clinical case of type 1 diabetes diagnosed for the first time in a child 3 years 8 months with COVID-19, and describes the further stage of treatment in the specialized endocrinology department. Conclusion. The clinical case presented by us, as well as data obtained as a result of research by domestic and foreign colleagues, confirm the existence of a pathogenetically determined relationship between COVID-19 and type 1 diabetes mellitus in children. To better understand the mechanisms underlying the devel- opment of metabolic suffering, it is necessary to create a single Global registry of patients with diabetes mellitus, first identified in connection with COVID-19.

Objective. To analyse aggregated AST results for key microorganisms collected through the 2022 reports of chief specialists in clinical microbiology and antimicrobial resistance. Materials and Methods. The study included an analysis of the interpretation criteria used in the laboratories and an evaluation of the AST reports. Data were obtained from the clinical microbiology and antimicrobial resistance annual reporting system. Reports were analyzed using EUCAST guidelines for expected resistance phenotypes and expected susceptible phenotypes. Data processing and analysis were realized using the «R» programming language. The 95% CI for the percentages of inaccuracies/errors distributed by federal districts was calculated using the Wilson method. Results. A combination of several interpretation standards was used in 27.78% of laboratories, MUK 4.2.1890-04 was noted as one of the options in 57.6% of laboratories. Irrelevant standards of interpretation with a lag of 1 year or more were used in a significant number of cases. The highest percentage of errors/ inaccuracies by the type «expected resistance» was observed for A. baumannii – 14,06% (N = 9163), E. faecium – 8,05% (N = 3451) and S. pneumoniae – 6,18% (N = 2779). «Susceptibility categorization in the absence of interpretive breakpoints» was highest for S. aureus – 13.24% (N = 19784) and S. pneumoniae – 8.76% (N = 3942). Rare phenotype was determined in the highest percentage in relation to S. pneumoniae and antimicrobials: vancomycin – 54.04% and linezolid – 64.6%. Conclusions. The study revealed a significant number of errors/inaccuracies in the data reported. The use of irrelevant interpretation criteria, the exclusion of situations with rare phenotypes and expected resistance, may contribute to a significant increase in the likelihood of inappropriate antibacterial prescribing.

Objective. To assess the practice of using antibiotics (AB) by the population of various regions of the Russian Federation (RF), by studying attitudes, behavior and knowledge about AB. Materials and Methods. The survey was conducted from February to June 2022 as part of a multicenter qualitative study in the form of a semi-structured interview among respondents from 18 to 74 years old who used systemic ABs of any group with or without a doctor's prescription for the treatment of symptoms of a confirmed or probable infectious disease for 3 months prior to the study. Individual inclusion criteria or respondents were developed for each of the participating centers (8 Federal Districts (FD) of the RF, Moscow, St. Petersburg), considering gender, age, education and place of residence to ensure the representativeness of the sample of the general population. Results. The study interviewed 300 respondents. Among them are 151 interviews with respondents who have a prescription for AB. A variety of reasons were identified for which the respondents did not go to the doctor: lack of time, fear of contact with additional infections in health facilities, positive experience with the use of a particular AB, confidence in the free purchase of AB in a pharmacy without a prescription. The data obtained testify to the high level of confidence of the interviewees in the experience and advice of others in the matter of starting AB therapy. A large role in the spread of resistance to AB belongs to the non-compliance of pharmacy workers with the requirements for the prescription sale of AB. As a rule, the respondents had no difficulty in purchasing AB without a doctor's prescription. Among ABs, combinations of penicillins with beta-lactamase inhibitors, penicillins, and macrolides were in greatest demand. An insufficient level of knowledge about the mechanism of action and indications for the use of AB was revealed. Data were obtained on the insufficient percentage of coverage of the population with information campaigns on the rational use of AB. A significant impact of the COVID-19 pandemic on an increase in the incidence of AB self-treatment has been demonstrated. Conclusions. The problem of excessive and irrational use of AB among the population in the RF still exists despite the ongoing measures. A lack of knowledge about antibiotics and low awareness of the problem of antimicrobial resistance were identified, and factors contributing to self-medication were identified. The data obtained can serve as a basis for the development of future initiatives to ensure the proper use of AB and, therefore, help to reduce the rate of selection of resistant microorganisms in the regions of the RF.

Aim: bring to the attention of practitioners indications for anti-Helicobacter therapy, methods and procedure for diagnostics and eradication therapy of Н. pylori infection.Key points. Chronic gastritis caused by Н. pylori infection, including asymptomatic persons, may be considered as an indication for eradication therapy of Н. pylori as etiological therapy and opportunistic screening for gastric cancer prevention. Indications, for obligatory anti-Helicobacter therapy include peptic ulcer, gastric MALT lymphoma, early gastric cancer (EGC) with endoscopic resection. H. pylori primary diagnostics methods include 13C-urea breath test, H. pylori stool antigen lab test, rapid urease test and serological method. The serological method cannot be used after anti-Helicobacter therapy.In Russia H. pylori strains' resistance to clarithromycin does not exceed 15 % in most regional studies. The first line therapy for Н. pylori infection eradication is the standard triple therapy including a proton pump inhibitor (PPI), clarithromycin and amoxicillin, enhanced with bismuthate tripotassium dicitrate. A classic four-component therapy based on bismuthate tripotassium dicitrate or quadrotherapy without bismuth drug products which includes PPI, amoxicillin, clarithromycin and metronidazole, may be used as alternative to the first line eradication therapy. The standard triple therapy may be prescribed for 14 days only in those regions, where it has been proven to be effective. Quadrotherapy with bismuthate tripotassium dicitrate is also used as main second line therapy in case of standard triple therapy, bismuth enhanced standard triple therapy or combined therapy failure. Another second line therapy includes PPI, levofloxacin and amoxicillin, to which a bismuth-containing drug product may be added. The third line therapy is selected individually based on previously used treatment settings.Conclusion. In each case of H. pylori infection the decision for eradication therapy should be made, which is especially relevant as eradication of H. pylori has been recognized as an effective measure for the prevention of gastric cancer.

Objective. To determine in vitro activity of thiamphenicol and other clinically available antimicrobials against clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes. Materials and Methods. We included in the study 875 clinical isolates from 20 Russian cities during 2018–2019. Among tested strains, 126 were H. influenzae, 389 – S. pneumoniae, 360 – S. pyogenes. Antimicrobial susceptibility testing was performed using broth microdilution method according to ISO 20776-1:2006. AST results were interpreted according to EUCAST v.11.0 clinical breakpoints. Results. The minimum inhibitory concentrations (MICs) of thiamphenicol did not exceed 2 mg/L for 94.4% of H. influenzae strains (MIC50 and MIC90 were 0.5 and 1 mg/L, respectively). Thiamphenicol was active against 76.9% of ampicillin-resistant H. influenzae strains (MIC of thiamphenicol < 2 mg/L). The MIC of thiamphenicol was in the range of 0.06–2 mg/L for 96.7% of S. pneumoniae strains (MIC50 and MIC90 were 0.5 and 2 mg/L, respectively). The MIC of thiamphenicol for 90.6% of S. pneumoniae strains with reduced susceptibility to penicillin (MIC of penicillin > 0.06 mg/L) did not exceed 2 mg/L. A total of 88.1% of S. pneumoniae strains resistant to erythromycin were highly susceptible to thiamphenicol (MIC < 2 mg/L). The MIC of thiamphenicol did not exceed 8 mg/L for 96.1% of S. pyogenes strains (MIC50 and MIC90 were 2 and 4 mg/L, respectively). Conclusions. Thiamphenicol was characterized by relatively high in vitro activity, comparable to that of chloramphenicol, against tested strains of H. influenzae, S. pneumoniae and S. pyogenes, including S. pneumoniae isolates with reduced susceptibility to penicillin.

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.