Aim. А determination of predictors of early placental abruption (up to 34 weeks of pregnancy). Design. Multicenter retrospective cohort study. Materials and methods. The total number of cases of placental abruption — 1594, data from 22 medical centers in 16 constituent entities of the Russian Federation. The main group (n = 618) — patients with placental abruption at a gestation period of less than 34 weeks, comparison group (n = 976) — pregnant women with placental abruption at 34 weeks or more. Results. Multivariate analysis carried out using the logistic regression method revealed a statistically significant effect of smoking, pregnancy number, the presence of a scar on the uterine abnormalities of its structure on the occurrence of early placental abruption. Conclusion. Disentangling placental abruption into early and late phenotypes may provide insight into the causes of this obstetric condition and improve maternal and neonatal outcomes. Keywords: placental abruption, predictor, risk factors, phenotype.

Anaphylaxis is a severe life-threatening emergency that requires prompt recognition, prompt respond and of lifesaving therapy. Therefore, anaphylaxis can develop both in a medical institution and outside it (outpatient), and physicians of any specialties should be ready to treat this condition. In this regard, clinical guidelines for anaphylaxis have been developed in Russia. Previous version of recommendations were approved by the Russian Association of Allergologists and Clinical Immunologists and the Federation of Anesthesiologists and Resuscitators, approved at a meeting of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (protocol No. 2020 No. 743/12). The second edition important clarifications have been made in etiology, epidemiology, classification, clinical picture, diagnosis, treatment and prevention of anaphylaxis and clear some definitions for prompt response, and also management of patients with concomitant diseases. Clinical guidelines of anaphylaxis are intended for practitioners of all specialties, students and teachers of medical universities, residents, graduate students.

The aim of the research. To identify prognostic factors for the development of sepsis in postpartum women who have suffered critical obstetric conditions (CAC). Materials and methods. We retrospectively examined 39 postpartum women after CAC, who were divided into groups: A – main group, with advanced sepsis (n = 18), B – control group without sepsis (n = 21). An analysis of clinical data upon admission was carried out. The results were processed using Statistica 12.0, Microsoft Excel and in the R environment. Results. Statistically significantly more often, patients in the main group gave birth before the 34th week of pregnancy, p = 0.04. About 50% of the subjects gave birth in first-level maternity facility. Preeclampsia and obstetric hemorrhage were the main causes of CAC development. Hemorrhagic shock occurred in 84,6% of subjects. All women underwent total hysterectomy. Sepsis developed on day 9 (4; 9) after delivery. It was shown that the chance of developing obstetric sepsis is 28 times more often in the case of artifical ventilation and at AVPU, 10 times – in case of adult respiratory distress syndrom, 7 times – in case of developed kidney failure, 6 times – in case of cerebral edema. When assessing the condition of postpartum women using the integral scales APACHE II, APACHE III, SOFA, NEWS2, a statistically significant OR in the development of sepsis remains only for the NEWS2 index; with a score of 4 points, the resulting model predicts the development of sepsis. The risk of developing obstetric sepsis is associated with MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45; in the presence of at least one of these factors, it increases by 7-8 times in terms of odds ratio (OR). Conclusion. The risk of developing obstetric sepsis in critical obstetric conditions is associated with the presence of mechanical ventilation and AVPU, adult RDS, renal failure, cerebral edema, a NEWS2 score of 4 or more points, MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45. The effectiveness of the developed prognostic model is: sensitivity – 94,5%, specificity – 90,5%.

Aim. Placental abruption is a severe complication of pregnancy, which is often accompanied by pre-eclampsia and early delivery. Here we aimed to study maternal and neonatal outcomes in patients with placental abruption depending on the severity of pre-eclampsia. Materials and Methods. The study included 509 patients with placental abruption and pre-eclampsia from 22 medical centers in 16 regions of the Russian Federation, which were divided into two groups: patients with placental abruption and severe pre-eclampsia (n = 369) and patients with placental abruption and moderate pre-eclampsia (n = 140). Results. Regardless of the severity of pre-eclampsia, average term of placental abruption was 34 weeks of pregnancy. Among the adverse maternal outcomes in patients with placental abruption and severe pre-eclampsia were coagulopathy (OR = 5.01; 95% CI = 1.17–21.46) and near miss proportion (OR = 2.95; 95% CI =1.22 –7.08) which were significantly more common as compared to a moderate pre-eclampsia. Neonatal outcomes were accompanied by a high perinatal mortality (12.8%) and neonatal morbidity due to a high prevalence of premature birth (65%), asphyxia (64%), and small for gestational age (40%). Groups with severe and moderate pre-eclampsia had no statistically significant differences in neonatal outcomes, excepting congenital malformations which were found less frequently (OR = 0.32; 95% CI 0.13–0.79) in severe pre-eclampsia. Conclusion. Severity of pre-eclampsia did not affect neonatal outcomes in women with placental abruption. Maternal outcomes were significantly worse in patients with severe pre-eclampsia in comparison with those with moderate pre-eclampsia.

Introduction. Septic complications after critical obstetric conditions (COC) are a pressing problem in obstetrics. The aim of the study is to conduct an integral assessment of the severity of postpartum women with septic complications after COC.Materials and methods. We examined 39 postpartum women after COC (massive obstetric hemorrhage, severe preeclampsia). All patients were divided into 2 groups: the main group (n = 18) — with associated septic complications, the comparison group (n = 21) — without septic complications. The average age of the subjects was (29.80±6.48) years.Results. Obstetric bleeding was complicated by hemorrhagic shock in more than 75 % of patients in both groups. Premature detachment of a normally located placenta (PDNLP) was statistically significantly more often recorded in the main group (p = 0.04). All patients underwent total hysterectomy during childbirth or in the early postpartum period. Multiple organ failure syndrome (MODS) occurred in all women of the main group and in 17/21 (80.95 %) in the comparison group (p = 0.05). When assessing the condition of maternity hospitals using integral scales, a higher number of points were noted in the main group on the APACHE II scale (p = 0.02), SOFA (p = 0.001), NEWS2 (p < 0.001). In the main group, septic complications developed on the 9 [4; 9] day after delivery.Conclusion. Risk factors for septic complications after COC are: MODS, renal failure, acute kidney injury, heart failure, respiratory distress syndrome, pneumonia. Maternity hospitals at risk of septic complications after COC initially show an increase in the number of points according to APACHE II, SOFA, NEWS2.

АКТУАЛЬНОСТЬ: Каждая пятая женщина испытывает высокоинтенсивную боль после кесарева сечения (КС). Периоперационное использование внутривенных адъювантов способно уменьшить интенсивность болевого синдрома. ЦЕЛЬ ИССЛЕДОВАНИЯ: Оценка эффективности низких доз кетамина в профилактике высокоинтенсивной боли у родильниц с низким болевым порогом после операции КС. МАТЕРИАЛЫ И МЕТОДЫ: Проведено рандомизированное контролируемое исследование, включающее 90 рожениц, родоразрешенных путем КС в условиях спинальной анестезии. Женщины были стратифицированы на две категории: с нормальным и низким болевым порогом. Внутри каждой страты пациентки рандомизировались на три группы: интраоперационное внутривенное введение кетамина в дозах 0,25 и 0,5 мг/кг и группа контроля. Оценка интенсивности послеоперационной боли проводилась в течение первых суток по цифровой рейтинговой шкале. Регистрировалось время до первого требования обезболивания и общая доза трамадола за сутки. Анализировалась частота побочных реакций. РЕЗУЛЬТАТЫ: Медиана и межквартильный интервал для средней интенсивности боли за первые сутки, боли при движении и в покое через 24 ч после КС были значительно выше в группе контроля по сравнению с группами кетамина (p < 0,001). Время до первого требования анальгезии увеличивалось в группе кетамина 0,5 мг/кг — 190,0 (175,0–195,0) мин по сравнению с группой контроля — 130,0 (130,0–140,0) мин с p < 0,001. Потребление трамадола в первые сутки было значительно ниже в группах кетамина по сравнению с группами контроля (p < 0,001). Межгрупповых статистически значимых различий по показателям боли в группах кетамина (0,5 и 0,25 мг/кг) не отмечалось ни у пациенток с нормальным, ни у пациенток с низким болевым порогом (p > 0,05). Побочные реакции в виде чувства искаженной реальности и нарушения зрения при минимальной дозировке 0,25 мг/кг наблюдались исключительно у пациенток с нормальным болевым порогом. ВЫВОДЫ: Для пациенток с исходно низким болевым порогом использование кетамина в дозе 0,25 мг/кг имеет наилучший профиль эффективности и безопасности.

Objective. To investigate the prevalence of carbapenemase-encoding genes carriage in patients at hospital admission. Materials and Methods. The prospective single-center cross-sectional study was performed in Moscow Multidisciplinary Clinical Center «Kommunarka» from 15.09.2022 till 15.08.2023. Adult patients without signs of gastrointestinal, upper and lower respiratory tract infections were included to research at fist 24 hour after hospital admission. Rectal swab and oropharyngeal swab were collected from each patient. Additional lower respiratory tract samples were collected from patients who were undergoing mechanical ventilation. The collected samples were tested by polymerase chain reaction using AmpliSens reagent kits to identify crabapenemase-encoding genes: blaOXA-58, blaOXA-51, blaOXA-40, blaOXA-23, blaVIM, blaIMP, blaOXA-48, blaNDM and blaKPC. Results. A total of 737 patients aged 18 to 94 were included, 442 of them were females and 295 were males. Carriage of genes in at least one locus was found in 12.6% of patients. 70.9% of patients carried only one type of genes, but 16.1% carried two different types of genes and 12.9% carried from 3 to 6 different types of genes. Males were carriers more often, then females (18.3% and 8.6% respectively). The most common gene was blaOXA-48 (23.1%), followed by blaNDM (15.4%). Genes blaKPC and blaOXA-51 were detected with the same frequency (14.7%). The other genes were less common, from 0.6% (blaIMP) to 10.3% (blaOXA-51). Genes blaOXA-48, blaNDM and blaKPC were more common in rectal swabs, and blaOXA-58 and blaOXA-51 predominated in upper respiratory tract samples. In lower respiratory tract samples blaOXA-48, blaKPC and blaOXA-51 occurred with equal frequency. In ICU patients the prevalence of carriage was 35.1% compared to 8.5% among ward patients. The carriage rate was the highest among patients from therapeutic wards (17.5%) and the lowest in patients from hematology wards (3.0%). Conclusions. Our study is one of the first in Russia to evaluate the prevalence of community-acquired carriage of carbapenemase genes. The features we discovered have potential clinical significance and allow us to draw some conclusions for our center, but multicenter studies of a similar design are needed to identify general patterns.

Objective: To evaluate a strategy for effective administrative control of targeted antimicrobial therapy in surgical intensive care unit (ICU) patients. Materials and methods. The study included 3522 patients who were treated in ICU No. 1 in the period 2022 to 2023. The first group (control), treatment period 2022, included 1764 patients. The second group (research), treatment period 2023, included 1758 patients. In both groups, the use of antimicrobial drugs (AMP) was carried out in accordance with the antibacterial therapy control strategy (ASCT); in group 2, systemic administrative control was additionally carried out in the form of the use of the “Effective Hospital” program and a developed analytical system with monitoring the financial stability of the unit, aimed at daily monitoring of operating activities. A comparative analysis of the frequency of use of various classes of antimicrobial agents, the incidence of infectious complications, mortality rates and financial costs between groups was performed. Results. There was a significant decrease in the consumption of AMPs of the carbapenem group from 8194 vials in 2022 to 6577 vials in 2023, which was a decrease of 19.7%; a decrease in the consumption of tetracycline group AMPs in 2023 compared to 2022, from 2338 bottles to 1581 bottles, which amounted to 32.4%; reduction in the consumption of vancomycin and linezolid in 2023 compared to 2022 from 562 vials to 313 vials, which amounted to 44.3%. There was a decrease in the incidence of VAP from 59.3 (57.6; 62.9) in 2022 to 48.1 (38.65; 61.9) units in 2023, which amounted to 10.8% (p = 0.053). The increase in the frequency of deaths from 10.9% (9.1; 12.4) in 2022 to 11.5% (10.5; 12.7) in 2023 did not have significant differences (p = 0.67). The total expenditure on AMP in 2023 significantly decreased by 22.3%, which allowed saving 1,477,205.53 rubles (p = 0.012). Conclusion. The use of a daily strategy of administrative control of operational activities and the use of antimicrobial therapy in the ICU can reduce the costs of expensive antimicrobial agents, reduce the incidence of nosocomial infectious and inflammatory complications without changing overall mortality.

Background. This study aimed to analyze the microviscosity of membranes and the surface charge of erythrocytes and blood plasma proteins using fluorescent zones in pregnant women before and after cesarean section (CS) with traditional management of the perioperative period and use of an accelerated recovery program. Materials and methods. The study included pregnant women without somatic or obstetric complications. They were divided into groups that received traditional management during the perioperative period (fasting for 8 h before surgery and administration of an antibiotic after clamping the umbilical cord) and used an accelerated recovery program. The relative microviscosity of the erythrocyte membranes was assessed using the lateral diffusion method with a hydrophobic pyrene probe (C16H10). The surface charge of erythrocytes and blood plasma proteins was determined using the fluorescent probe 8-anilino-1-naphthalene sulfonic acid. Results. In postpartum women with an accelerated recovery program, the immersion of proteins in the lipid bilayer of the erythrocyte membrane decreased. The coefficient of pyrene eximerization in areas of protein–lipid contacts in the same group was higher and further increased both after anesthesia and after surgery. In the traditional management group, an increase in the eximerization coefficient was registered only after CS. In the areas of lipid–lipid contacts, the coefficient of pyrene eximerization in the accelerated recovery program group was significantly higher than that in the control group. Changes in the eximerization coefficient after anesthesia and surgery were insignificant. Moreover, the polarity of the microenvironment of both anular lipids and total lipids did not change. Conclusions. An increase in the pyrene eximerization coefficient in patients on an accelerated recovery program indicates a decrease in the microviscosity of erythrocyte membranes and an increase in their fluidity, which may be due to structural rearrangements of cell membranes and leads to an increase in their functional activity. The components of the accelerated recovery program affect the microviscosity of erythrocyte membranes, particularly in the areas of protein–lipid contacts, which may positively affect microcirculation in the perioperative period, which plays a significant role in the genesis of postoperative complications.

Introduction . Despite the use of modern principles of treatment of severe preeclampsia, mortality rates for mother and newborn in the development of life-threatening complication of preeclampsia, such as HELLP syndrome, remains high. The introduction of accurate models of early diagnosis and prediction of the probability of manifestation and severity of the HELLP syndrome into everyday medical practice will improve the safety of delivery of pregnant women with severe preeclampsia. The aim of the study is to determine the current state of the issue and systematize current data on methods of predicting the probability of HELLP syndrome manifestation. Materials and methods. An analytical review of the literature. A qualitative analysis of clinical trials and reviews on prediction of HELLP syndrome was conducted using the following data sources: PubMed and Google Scholar. The search was carried out in Russian and English, using the keywords “predictors”, or “prediction”, and “HELLP syndrome”. The date of the last search query is 22 March 2024. Results . Anamnestic data and initial characteristics of patients with HELLP syndrome were analyzed. Discussion . The analytical review included publications devoted to the study of the influence of predictive capabilities of potential biochemical markers, clinical and anamnestic signs and instrumental examination data on the probability of HELLP syndrome development. Conclusion . Adequate prediction of the manifestation of HELLP syndrome is possible on the basis of a comprehensive analysis of all identified factors, allowing the identification of effective prognostic models to improve maternal and fetal outcomes in pregnant women with severe preeclampsia.

Introduction . The choice of the method and time of initiation of extracorporeal detoxification (ECD) in septic shock (SSh) complicated by acute kidney injury (AKI) is a debatable problem.The objective was to evaluate the influence of various ECD tactics on the dynamics of markers of systemic endotoxicosis and acid-base status (ABS) in patients with SSh complicated by AKI.Materials and methods. Study included 57 patients. Group 1 – 36 patients used continuous veno-venous hemodiafiltration (CVVHDF) for urgent indications. Group 2 – 21 patients used early combined ECD (LPS-sorption and CVVHDF). A comparative analysis of the main laboratory parameters between the groups was performed.Results. Early combined ECD made it possible to reduce the concentration of leukocytes by the 3rd day of therapy from 20.6 to 12.5 ·109/l (39.3 %) from the initial level in group 2, and from 22.2 to 19.15·109/l (13.7 %) in group 1 ( p=0.04); C-reactive protein by the 5th day of therapy from 284 to 145 mg/l (48.9 %) in group 2, and from 299.3 to 199.8 mg/l (33.2 %) in group 1 ( p=0.02); procalcitonin by the 5th day of therapy from 7.2 to 1.6 ng/ml (77.8 %) in group 2, and from 7.8 to 4.45 ng/ml (42.9 %) in group 1 ( p= 0.02); pH by the 3rd day of therapy from 7.17 to 7.37 in group 2, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).Conclusions. Early combined ECD more quickly reduces markers of systemic endotoxicosis and eliminates impairment of ABS, than CVVHDF.

INTRODUCTION: Identification of risk factors that cause a high probability of an unfavorable outcome in the postoperative period is an urgent problem. The creation of national databases (registries) makes it possible to cover a certain patient population by identifying its risk predictors. Existing registries differ in the criteria for inclusion in the study, in the characteristics of the populations studied, and there is often no common view on the classification of postoperative outcomes. OBJECTIVE: Creation of a Russian national calculator for the risk of postoperative complications and mortality. MATERIALS AND METHODS: Two-level observational retrospective-prospective study. Setting: National multicenter study of surgical inpatients. Patients: Adult patients undergoing elective and emergency surgery. Types of interventions: obstetrics, gynecology, mammary gland, urology, endocrine surgery, maxillofacial surgery, orthopedics, traumatology, abdominal surgery, liver and biliary tract, thoracic surgery, vascular surgery, neurosurgery, cardiac surgery, other areas. RESULTS: The design was registered in the ClinicalTrials.gov database, the study was organized by the Federation of Anesthesiologists and Reanimatologists of Russia. Primary (30-day mortality, 30-day complications) and secondary (hospital mortality, hospital complications, length of stay in ICU, length of hospital stay, multiple organ failure (2 or more points on the SOFA scale), 90-day mortality, 90-day complications, post intensive care syndrome, readmission, 1-year mortality) outcomes; six primary and twelve secondary target points; criteria for inclusion, non-inclusion, exclusion. The required sample size and statistical analysis are described. The planned sample size to ensure the required power of the study is determined to be 60,800 observations for elective surgery and 20,000 observations for emergency surgery. The planned duration of the study is 2024–2028. CONCLUSIONS: The study has important scientific and medical-social significance; a Russian national calculator for the risk of postoperative complications and mortality will be developed. In the future, the developed calculator can become the basis for making medical decisions.

Introduction. The issues of managing postpartum women with infectious and inflammatory diseases (IID) are extremely relevant in modern conditions.The aim of the study is to present the clinical characteristics and features of treatment of women in labor with various forms of postpartum pulmonary dysfunction.Materials and methods. A retrospective examination of 181 postpartum mothers with IID was carried out, who were divided into 3 groups: A (n = 122) — patients with uncomplicated endometritis; B (n = 43) — with complicated forms (suture failure, metrothrombophlebitis); C (n = 16) — with severe septic complications (parametritis, obstetric peritonitis).Results. In groups B and C, chorioamnionitis was statistically significantly more often diagnosed during labor compared to uncomplicated endometritis (pA–B = 0.002, pA–C < 0.001). In the integrated the number of points on the NEWS2 scale was statistically significantly higher in group B (p = 0.050) and group C (p = 0.007) compared to group A. In 25.42 % of the subjects, there was a discrepancy between the prescribed empirical antibacterial therapy and the pathogen isolated. In group B, organ-preserving surgery was performed in 55.81 % of the mothers on day 6.5 [4.8; 11.0], and hysterectomy was performed on day 9.0 [6.0; 12.0] after delivery.Conclusion. Chorioamnionitis during childbirth, a score on the NEWS2 scale of 2 or more points suggests the development of complicated forms of postpartum endometritis. When treating, preference should be given to antibiotics of the aminopenicillin group, amoxicillin and beta-lactamase inhibitors, carbapenems and a timely decision should be made on repeated surgical intervention, allowing for organ-preserving surgery.

АКТУАЛЬНОСТЬ: Инфузионная терапия — основной метод коррекции патологических изменений, которые возникают в фазу «асептического» воспаления при остром панкреатите. ЦЕЛЬ ИССЛЕДОВАНИЯ: Обобщить актуальные данные о схемах инфузионной терапии у больных с острым деструктивным панкреатитом, целесообразности применения различных инфузионных растворов и вариантов мониторинга эффективности терапии. МАТЕРИАЛЫ И МЕТОДЫ: Исследование выполнено в соответствии с международными требованиями отчетности для обзоров (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Поиск осуществлялся в поисковых системах сети Интернет Pubmed и Cochrane Controlled Clinical Trials Register. Для отбора статей также был применен метод поиска по ссылкам литературы. Стратегия поиска не предусматривала ограничений по языку, типу и дате статьи. РЕЗУЛЬТАТЫ: Проведенный анализ данных литературы выявил два подхода к инфузионной терапии. Первоначальный интерес к «агрессивным» (4 л/сут и более) схемам инфузионной терапии в первые 24 ч заболевания в настоящее время сменился тенденцией к менее «агрессивным» схемам в связи с появившимися работами о высокой частоте различных осложнений (прогрессирование органной дисфункции, местные осложнения). Рассматривая качественный состав инфузионной терапии, безусловно, предпочтение следует отдавать кристаллоидам. Базовый мониторинг инфузионной терапии должен включать неинвазивные методы: частоту сердечных сокращений, среднее артериальное давление, темп диуреза. ВЫВОДЫ: Анализ продемонстрировал различные подходы к тактике инфузионной терапии у данной категории больных. Необходимо дальнейшее исследование вопросов эффективности и безопасности инфузионной терапии с учетом различной степени тяжести острого панкреатита, возможности влияния качественного состава инфузии на течение данного заболевания и формирование рекомендаций стартовой и поддерживающей инфузионной терапии, основанных на принципах персонализированной медицины.

АКТУАЛЬНОСТЬ: Выявление факторов риска, обусловливающих высокую вероятность неблагоприятного исхода в послеоперационном периоде, является актуальной проблемой. Создание национальных баз данных (регистров) позволяет максимально охватить определенную популяцию пациентов, выявив характерные для нее предикторы риска. Как показывают данные литературы, существующие регистры различаются в критериях включения в исследование, в характеристиках изучаемых популяций, часто отсутствует единый взгляд на классификацию послеоперационных исходов. ЦЕЛЬ ИССЛЕДОВАНИЯ: Создание российского национального калькулятора риска послеоперационных осложнений и летальности. МАТЕРИАЛЫ И МЕТОДЫ: Двухуровневое обсервационное ретроспективно-проспективное исследование. Условия: национальное многоцентровое исследование пациентов хирургических стационаров. Пациенты: взрослые пациенты, подвергающиеся плановым и экстренным оперативным вмешательствам. Виды вмешательств: в акушерстве, в гинекологии, на молочной железе, в урологии и на почках, в эндокринной хирургии, в челюстно-лицевой хирургии, в ортопедии и травматологии, на нижнем этаже брюшной полости, на печени и желчевыводящих путях, на верхнем этаже брюшной полости, в торакальной хирургии, в сосудистой хирургии, в нейрохирургии, в кардиохирургии, в других областях (с обязательной конкретизацией). РЕЗУЛЬТАТЫ: Разработанный дизайн был зарегистрирован в базе данных ClinicalTrials.gov, исследование организовано Федерацией анестезиологов и реаниматологов России. Определены первичные (30-дневная летальность, 30-дневные осложнения) и вторичные (госпитальная летальность, госпитальные осложнения, длительность пребывания в отделениях анестезиологии, реанимации и интенсивной терапии, длительность пребывания в стационаре, полиорганная недостаточность (2 балла и более по шкале SOFA (Sequential Organ Failure Assessment), 90-дневная летальность, 90-дневные осложнения, синдром последствий интенсивной терапии, повторная госпитализация, годовая летальность), исходы; 6 первичных и 12 вторичных целевых точек; критерии включения, невключения, исключения. Описаны необходимый размер выборки и методы статистического анализа. Планируемый объем выборки для обеспечения требуемой мощности исследования определен в 60 800 наблюдениях для плановых операций и 20 000 наблюдений для экстренных операций. Планируемые сроки проведения исследования — 2024–2028 гг. ВЫВОДЫ: Исследование имеет важное научное и медико-социальное значение, в результате анализа полученных данных будет разработан российский национальный калькулятор риска послеоперационных осложнений и летальности. В перспективе разработанный калькулятор может стать основой для принятия медицинских решений.

Objective. To determine etiological structure of infections in the surgical intensive care unit (ICU), identify the most common mechanisms of antibiotic resistance of leading pathogens, and develop recommendations for optimizing antimicrobial therapy in the ICU at the present stage. Materials and Methods. A prospective observational study was conducted in the surgical ICU of the Moscow City Clinical Center "Kommunarka" from September 2022 to February 2024. The subjects of observation were 2120 patients treated in the unit. Microbiological examination of patients' biological fluids was carried out in accordance with approved methodological guidelines. The results of determining the susceptibility of isolated pathogens were interpreted based on the EUCAST v14.0 criteria. Automatic bacteriological analyzers, MALDI-TOF mass spectrometry for pathogen identification, PCR and immunochromatographic methods for determining resistance mechanisms were used. To determine the etiological structure of infections in hospitalized patients, only original isolates were considered, following the principle of "one patient – one microbe." Results. A total of 1213 bacterial and 53 fungal pathogens were isolated from 394 patients. The leading pathogens were Klebsiella pneumoniae (18.5%), Acinetobacter baumannii (13.4%), and Pseudomonas aeruginosa (9.5%). Resistance to meropenem was 83.0% for K. pneumoniae, 97.4% for A. baumannii, and 81.5% for P. aeruginosa. The highest in vitro activity against Enterobacterales was exhibited by ceftazidime-avibactam (79.2% of susceptible isolates), while against A. baumannii and P. aeruginosa, it was colistin (98.6% and 90.6% of susceptible isolates, respectively). The genetic mechanisms of carbapenem resistance in Enterobacterales were identified: production of NDM (26.3%), OXA-48 (29.6%), and KPC (44.1%) carbapenemases. Conclusions. The predominant pathogens of infections in surgical ICU patients are gram-negative bacteria with a high level of antibiotic resistance, including carbapenem-resistant Enterobacterales, whose resistance is due to the production of carbapenemases of various molecular classes. An increase in the prevalence of the serine carbapenemase KPC, previously atypical for the Russian Federation, has been noted. Currently, for infections caused by Enterobacterales producing serine carbapenemases, ceftazidime-avibactam can be recommended, and in the case of metallo-beta-lactamase production by Enterobacterales, a combination of ceftazidime-avibactam with aztreonam. For infections caused by A. baumannii and P. aeruginosa, regimens including polymyxins are indicated.