«THE END OF THE ERA OF ANTIBIOTICS» - MYTH OR REALITY: WHAT THE PAST COVID-19 PANDEMIC HAS SHOWN

Against the backdrop of the past pandemic of a new coronavirus infec-tion in Russia, there was a significant increase in the sale of AMPs in the pharmacy network and their purchases by medical institutions of the healthcare system of the Russian Federation. Microbiological monitoring conducted at the City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department (Moscow) in 2020-2021 revealed the presence of an urgent problem, which is that patients with HAIs are now mainly isolated from gram-negative bacteria, the pool of which is dominated by multidrug-resistant strains (MDRs). As pharmacoeconomic studies have shown, the cost of one course of targeted antibiotic therapy for HAIs in this case can increase by 6-12 times compared to a similar course of therapy in the absence of MDR and XDR strains of nosocomial pathogens. In order to achieve a reduction in the cost of antibacterial therapy regimens developed and used by the authors, simultane-ously with the development of effective antibiotic regimens for HAIs caused by MDR/XDR pathogens, a study was carried out, which is a continuation of the work on the creation and improvement of biotherapy regimens for HAIs, i.e. the development of personalized phage therapy regimens for patients with nosocomial pneumonia caused by strains of bacteria with MDR. The concept of a personalized approach to phage therapy of various nosological forms of HAIs in patients of a multidisciplinary hospital caused by nosocomial pathogens with MDR has been proposed and tested. With the use of this medical technol-ogy, the effectiveness of phage therapy of various nosological forms of HAIs in the City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department, caused by MDR and XDR strains of nosocomial pathogens, increased by 30%, the effectiveness of the initial antibiotic therapy regimen was 70%. The economic effect of the combination of antibiotic therapy and phage therapy («booster therapy») amounted to 3 million rubles compared to the use of AMP alone in the treatment of patients with HAIs caused by MDR/XDR strains of nosocomial pathogens. The use of «booster therapy» as one of the variants of «IIB therapy» reduces the cost of treatment of various forms of hospital-acquired infection by 2.5 or more times than just prescribing only antibiotics.