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The current literature lacks data on the incidence of intraoperative awakening during xenon anesthesia. This could be due to amnesia preventing memories of the intraoperative awakening.The objective: to determine the concentration of xenon in the xenon-oxygen mixture, which causes amnesia for events during inhalation in 100% of patients, and to make correlations with the depth of hypnosis as per Kugler scale.Subjects and Methods: 34 patients with chronic neurogenic pain who received 111 20-minute inhalations with concentration of xenon up to 50% were included in the study. Amnesia evaluation, EEG monitoring, and pain assessment on a visual analog scale (VAS) were performed.Results. Amnesic effect developed in 100% of patients at xenon concentration of 45%. On inhalation of xenon at concentrations of up to 50%, EEG changes did not exceed D1 grade on Kugler scale. The decrease in bispectral index (BIS) did not reach the level of deep sedation (Me 96.2%) at xenon concentration of 50%. The decrease in pain on VAS was approximately 60%.Conclusions. Xenon inhalations cause transient congradic amnesia at concentrations of 45% or more. The accuracy of the BIS monitoring readings may be reduced when using xenon in a monovariant. Inhalations of xenon-oxygen mixture in concentrations up to 50% showed good analgesic properties in the framework of combined therapy of chronic pain syndrome.

Management of elderly and senile patients is a major challenge due to significant comorbidity, especially in surgery under general anesthesia.The aim of the review was to identify the optimal method of anesthesia for knee arthroplasty in elderly patients based on the available clinical and experimental studies.We searched PubMed, Medline, and Elibrary.ru databases for relevant sources. Out of more than 300 publications initially analyzed, 113 literature sources (dating from 1951 to 2021) were included in the review, of which 80 were published within the last five years (2016–2021). The inclusion criteria were high informative value and relevance, except for sources cited as historical references. Both randomized multicenter studies and individual case reports were included in the review. Exclusion criteria were low informative value, outdated and repetitive data.We reviewed the physiology of elderly and senile patients, various variants of anesthesia, the use of neuroaxial anesthesia and peripheral regional blocks, xenon-based general anesthesia, assessed the advantages and drawbacks of each method, and discussed the monitoring of the depth of anesthesia and the issues of inraoperative awareness during knee arthroplasty in elderly and senile patients.Conclusion. The choice of anesthesia for knee arthroplasty in elderly and senile patients should be based on the risks of decompensation of cardiovascular comorbidities and cognitive impairment. No known anesthetic method is ideal in terms of safety. The use of xenon as the main anesthetic seems promising due to its cardio- and neuroprotective properties. However, its use is limited due to relatively high cost. Therefore, the search for optimal (lower than recommended) inhalation concentrations may lead to expanding use of xenon in elderly and senile patients. At the same time, the use of lower concentrations of the drug is associated with the intraoperative awakening and the need for its combination with narcotic analgesics or amnestic agents, which may not be optimal. In addition, the protective effect of xenon retrograde amnesia against the stress of unintended intraoperative awakening has not been studied, and routine methods of monitoring the depth of hypnosis when using xenon often yield skewed measurement results inconsistent with the clinical manifestations of anesthesia.Therefore, there is a need for further studies concerning the retrograde amnesic effect of xenon and search for optimal methods of assessing the depth of hypnosis when using this gas to safely reduce its inhalation concentration.

Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread In most regions of the world including Russia. It is clear that it affects both the effectiveness of antimicrobial therapy and tactics and strategy of its use not only in adults patients but also in children. The pandemic of coronavirus infection, in addition, highlighted the growing problems in treatment of invasive mycoses, the dose adjustment of antibiotics during sorption and dialysis therapy methods. These circumstances made it necessary to make adjustments to Guidelines on Diagnostics and Antimicrobial Therapy of Infections Caused by Multiresistant Strains of Microorganisms, which were prepared by a group of leading Russian experts in 2020 [1]. The submitted version of the recommendations was approved on 25.03.2022 at a joint meeting of the working group with representatives of public organizations: Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum. These recommendations reflect an interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by multiresistant microorganisms. They are based on data from publications obtained from randomized trials as well as based on international clinical guidelines with a high degree of evidence.It is rational to use the Guidelines for determining the tactics of empirical and etiotropic therapy of the most severe infections.

A retrospective analysis of the medical data of 12 patients with COVID-19 was performed. For the diagnosis of invasive aspergillosis the international criteria ECMM/ISHAM 2020 were used. We analyzed the scientific literature data on the diagnosis and treatment of invasive aspergillosis in patients with COVID-19.Results. Among the 12 examined patients with a severe course of COVID-19, invasive aspergillosis was diagnosed in 5 patients. Four patients (80%) were treated in the ICU. Steroids or interleukin-6 inhibitors were used in 80% patients. Severe lymphocytopenia was in 80% patients, neutropenia 20%. A fever refractory to antibiotic therapy was noted in 80% patients, an increase in respiratory failure – 60%, acute respiratory distress syndrome – 60%. All patients showed negative dynamics of changes in the chest CT scan. Invasive aspergillosis was confirmed with a positive test for galactomannan in bronchoalveolar lavage and / or serum in 100% of cases. All patients received antifungal therapy with voriconazole and/or caspofungin. The overall 12-week survival rate was 80%.Conclusion. In ICU patients with severe COVID-19 and progressive pulmonary symptoms invasive aspergillosis should be excluded. Examination of substrates from the lower respiratory tract (BAL, tracheal aspirate, or nonbronchoscopic lavage) is necessary. Laboratory examination should include microscopy, culture and test for galactomannan. Voriconazole and isavuconazole are drugs of choice for the treatment of invasive aspergillosis in patients with COVID-19.

Relevance. Staphylococci are one of the most common pathogens in the etiological structure of nosocomial infections. Methicillinresistant staphylococci are resistant to the main groups of antibiotics and are one of bacteria that pose the greatest threat to human health according to the World Health Organization. The introduction of modern molecular biological methods in the monitoring of methicillin-resistant staphylococci is necessary for the rapid and accurate identification of microorganisms, monitoring the epidemiological situation and studying the need for anti-epidemic measures. Aims. Аnalysis of the results of monitoring methicillinresistant staphylococcus strains using molecular biological methods in a multidisciplinary hospital in Moscow for one year. Materials and methods. Single-center observational study with a one-year follow-up period (December 2016 to December 2017). The research included a molecular-biological analysis of biological material from 240 patients with signs of infection and washings samples (n=250) from the objects of the hospital environment. The whole genome sequencing was carried out for 24 samples, isolated from patients with different forms of staphylococcal infection and washings from a hospital environment. DNA detection of methicillin-resistant strains was performed using the «AmpliSens®MRSA-screen-titer-FL» reagent kit. Sequencing was performed on an Illumina HiSeq1500 instrument using the IlluminaHiSeq PE RapidClusterKit v2 and IlluminaHiSeqRapid SBS Kit v2. Results. DNA of methicillin-resistant staphylococci were detected in 6.3% of blood samples from patients with signs of infection and in 42.4% of washings from the objects of the hospital environment. The results of PCR of washing samples showed that DNA of methicillin-resistant coagulase-negative staphylococci were detected much more often than MRSA (p

The COVID-19 outbreak started in December 2019 in China has spread over all countries of the world within few month acquiring a pandemic nature, the incident population counting millions. The pathogenic mechanisms of the new coronaviral infection caused by never-before-seen virus SARS-CoV2 are yet to be studied. Various drugs are used for COVID-19 treatment and guidelines are continuously revised as new experience is acquired. In the current pandemic situation, it is important to provide specialists with latest information concerning efficacy and safety drugs for COVID-19 patients and promising research in this field.The purpose of the review is to critically analyze published data on outcomes of COVID-19 treatment with various drugs including potentially promising drugs.The search has been carried out through such databases as PubMed, Scopus, Cyberleninka, https://www.globalclinicaltrialsdata.com, https://clinicaltrials.gov, Cochrane Library; mostly, randomized clinical trials-2020 and papers dedicated to candidate drugs have been considered. The paper is structured based on the drug’s action mechanism and contains parts dedicated to antiviral, immunomodulatory, and antibacterial therapies. Looking for a new promising target in COVID-19 treatment, the authors focus their attention on matrix metalloproteinases (MMP), which abundance results in the destruction of extracellular matrix, epithelial and endothelial basal membranes and leads to secondary lung tissue injury. The paper provides a theoretic justification of MMP inhibitor use by an example of doxycycline and offers an efficacy study protocol for the new approach to COVID-19 therapy.Conclusion: as of now, there are no drugs which efficacy for COVID 19 has been proven. Drugs possessing multiple mechanisms of action are employed beside their specified indications, often in combinations; in this situation, additive side effects with adverse consequences for the patient can hardly be avoided. Administration of drugs with unproven efficacy may be justified only in clinical trials followed by subsequent analysis and publication of findings demonstrating that in case of success, recommendations for a majority of COVID-19 patients could be confidently issued.

Introduction. Strains of microorganisms resistant to antimicrobial agents are commonly found in medical units throughout most regions of the world, including Russia. This leads to lower antimicrobial therapy efficacy when treating nosocomial infections. In this regard, the timely implementation of adequate antibiotic therapy is of great importance.The objective of the guidelines: To provide summarized information on contemporary approaches to microbiological diagnostics and the assessment of results, as well as the principles of rational use of antimicrobial and antifungal agents, including treatment of infections caused by multiple drug-resistant strains of microorganisms.Subjects and methods. These guidelines are based on published data obtained in the course of randomized trials, as well as information presented in the provisions of international guidelines supported by high-level evidence. The guidelines were prepared by a working group of Russian experts with extensive experience in research and practical work in this area. On October 11, 2019, the final version of the guidelines was reviewed and approved at a joint meeting of the working group and representatives of the public organizations which initiated the development of these guidelines (Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), NGO Russian Sepsis Forum).Conclusion. The guidelines reflect an interdisciplinary consensus of approaches to the diagnostics and antibiotic therapy of infections caused by multiresistant microorganisms. The provisions set forth should be used to decide on the strategy of empirical and etiotropic therapy of the most severe infections.

Objective. Evaluate the change of etiological structure and clinical outcomes of bacteremia in surgical patients after the implementation the system of monitoring and control antibiotic resistance in a multidisciplinary hospital.Materials and methods. Interventional study with historical controls. The intervention: antibiotic stewardship program, including a group of experts on antimicrobial therapy, antimicrobial therapy and prophylaxis protocols, infection control, improving hospital bacteriological laboratory, educational programs, internal audit. Study onset: June 2013. Analysis of pre-intervention (Jan. 2011-June 2013) and intervention (July 2013-Dec. 2015) periods was carried out. We assessed incidence of bacteremia caused by methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), ESBL-producing Enterobacteriaceae, MDR Gram-negative nonfermenting bacteria (MDR-NFGB), incidence of candidemia, hospital length of stay (LOS) and mortality of surgical patients with bacteremia.Results. In the intervention period a significant decrease in the incidence of bacteremia caused by MDR-NFGB from 50 (14,8%) to 16 (4,7%), р

The purpose of the study is to assess the possibility of managing the antibiotic resistance level and consumption of antimicrobial agents in a hospital based on the analysis of the drug resistance index.Material and methods. The antibiotic consumption planning system was employed at the multidisciplinary surgical hospital based on the unified Registry of microorganisms (ROM). ROM included data on 25.581 strains obtained from patients with infections admitted to the intensive care units (ICU) and specialized departments. Protocols of empiric antimicrobial therapy and perioperative antibiotic prevention were developed. The ROMbased system allowed automated calculation of drug resistance indices for nosocomial microor ganisms. Data obtained during the preintervention period (2012) and intervention period, (2014—2015) were compared. Results. Decreases in the drug resistance indices for Pseudomonas aeruginosa from 0.721 in 2012 to 0.596 in 2015, Acinetobacter baumannii from 0.96 in 2012 to 0.889 in 2015, Klebsiella pneumoniae from 0.728 in 2012 to 0.595 in 2015 were achieved due to reduction of antimicrobial resistance, reduced consumption of III—IV generation cephalosporins and antipseudomonal carbapenems, and more frequent use of ertapenem for treatment of infections caused by Klebsiella pneumoniae. There was an increase in the drug resistance index of Escherichia coli from 0.325 in 2012 to 0.382 in 2015 due to increased consumption of protected penicillins and first generation cephalosporins for prevention in abdominal surgery and urology and increased pathogen resistance to these antibiotics.Conclusion. A development of a unified hospital ROM and application of the drug resistance index for math ematical modeling of the pathogens resistance level allows to perform timely monitoring of changes in antibiotic resistance of nosocomial microorganisms in ICU setting and other hospital departments and proper managinge the antibiotics prescription.