Focus Of Infection Research Articles

Рабдомиолиз — редкое внелегочное проявление внебольничной пневмонии, вызванной Mycoplasma pneumonia

Aim. To present a clinical case of a 19-year-old patient with community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae, which was complicated by a rare extrapulmonary manifestation in the form of rhabdomyolysis. Key points. The clinical case demonstrates a variant of mycoplasma CAP in an adult patient. M. pneumoniae infection was confirmed by a positive PCR test. Characteristic is contact with a patient with mycoplasma CAP in an infectious focus, a flu-like onset of the disease. Unlike most mild mycoplasma infections with a minimally expressed clinical picture and inflammatory response, the patient had a long period of febrile temperature and severe intoxication, significant laboratory changes and bilateral polysegmental lung damage. The development of signs of rhabdomyolysis (myalgia, increased creatine phosphokinase (CPK) to 2066 U/L, myoglobinuria) in the acute period of the disease is a rare extrapulmonary manifestation of mycoplasma CAP in adults, dangerous for the development of acute renal failure (ARF). Conclusion. The patient's young age, timely initiation of hydration, and antibacterial therapy aimed at M. pneumoniae made it possible to prevent the development of acute renal failure due to rhabdomyolysis. An increase in CPK, in the absence of other explanations for this phenomenon, should include mycoplasma CAP in the differential diagnosis of rhabdomyolysis. Keywords: community-acquired pneumonia, Mycoplasma pneumoniae, creatine phosphokinase, rhabdomyolysis.

Влияние антропогенных факторов на активность клещей семейства Ixodidae: история исследований в России

While studying the characteristics of the formation and existence of foci of transmissible tick-borne infections, it is essential to consider both natural and anthropogenic factors. The impact of human activity on this process undoubtedly requires constant attention. Retrospective studies conducted in our country and the post-Soviet space within this framework are systematized in this review according to the following periodization: the observation and knowledge accumulation stage; the fundamental research enhancement stage; and the contemporary stage. The review provides a characterization and trend analysis of studies on the anthropogenic impact on populations of ticks from the Ixodidae family, highlighting the most significant scientific works and results obtained on the subject. The concluding section emphasizes the importance of accumulating and structuring research to ensure the epidemiological well-being of the population.

ЗАБОЛЕВАЕМОСТЬ ИКСОДОВЫМ КЛЕЩЕВЫМ БОРРЕЛИОЗОМ У ЖИТЕЛЕЙ КРАСНОЯРСКОГО КРАЯ, ПЕРЕНЕСШИХ COVID-19

A retrospective epidemiological analysis of the incidence of natural focal zoonotic infections among the human population in the Krasnoyarsk Kray showed that the increase in the incidence of ixodid tick-borne borreliosis in 2022 could be caused by an increase in the number of people with post-acute COVID-19 syndrome, who probably have dysregulation of the immune response and increased sensitivity to various pathogens. There were no significant gender differences in infectious sensitivity to Borrelia in people who underwent COVID-19. At the same time, among people diagnosed with borreliosis, the proportion of women who have previously had COVID-19 is increased. The same happens with tick-borne encephalitis: a higher infectious sensitivity of women to the encephalitis virus is a statistically justified fact in people who have undergone COVID-19. Key words: COVID-19, ixodid tick-borne borreliosis, Krasnoyarsk Kray

An acidity-triggered aggregation nanoplatform based on degradable mesoporous organosilica nanoparticles for precise drug delivery and phototherapy of focal bacterial infection.

It is crucial to precisely strike the bacterially infected area and avoid damaging healthy tissue in bacterial infection treatment. Herein, we report an acidity-triggered aggregation antibacterial nanoplatform based on biodegradable mesoporous organic silica nanoparticles (MON NPs). The surface of MON NPs modified with polydopamine (PDA) encapsulated ciprofloxacin (CIP) and methylene blue (MB) and was then further grafted with glycol chitosan to obtain MB/CIP@MON-PDA-GCS NPs (MCMPG NPs). In the bacterial infection environment with acidic characteristics, glycol chitosan (GCS) becomes positively charged. Consequently, the positively charged acidity-triggered GCS enables MCMPG NPs to accumulate on the negatively charged bacterial surfaces in the infected area and not in healthy tissue. The targeted method allows for the precise release of CIP and MB, ensuring the spatial accuracy of photodynamic therapy (PDT) and photothermal therapy (PTT) for effective bacteria-specific treatment.

Evaluation of Candidemia in Solid-Organ Transplant Recipients.

Solid-organ transplant recipients have high rates of invasive fungal infections. Candida species are the most commonly isolated fungi. Our aim was to identify risk factors, clinical presentations, and outcomes of candidemia in solid-organ transplant recipients. We evaluated adult (≥18 years old) transplant recipients seen from May 2011 to December 2022 at Baskent University Ankara Hospital. From medical records, we retrospectively reviewed age, sex, transplant type, candidemia agent, risk factors, concomitant infections, and mortality of patients with Candida detected in blood culture. We used SPSS statistics software (version 25) to analyze data. There were 1080 organ transplants performed during the study period (717 kidney, 279 liver, 84 heart). There were 855 who were ≥18 years (655 kidney, 127 liver, 73 heart), of whom candidemia was detected in 26 (16 male; 11 kidney, 11 liver, 4 heart) with a median age of 47.5 years. The most common agents were Candida albicans and Candida glabrata. The most common chronic diseases were hypertension, cirrhosis, and cardiomyopathy. Eighteen patients had a concomitant focus of infection. Ten patients had pneumonia accompanying candidemia. The 30-day mortality rate was as high as 53.8%. The mean duration of candidemia after transplant was 23 months. Catheter-related candidemia was observed in 65% of patients. The 30-day mortality was found to be significantly higher in patients followed in the intensive care unit (P = .014), receiving total parenteral nutrition (P = .001), using broad-spectrum antibiotics (P = .001), and having pneumonia (P = .042) accompanying candidemia. For adult solid-organ transplant recipients with candidemia, careful monitoring is essential for successful management of total parenteral nutrition, central catheter, use of broadspectrum antibiotics, and invasive interventions.

Prevalence of dental caries in a pediatric population during the COVID-19 omicron pandemic era in South India.

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study was to assess the prevalence of oral foci of infection in a multispeciality hospital during the pandemic in Chennai, South India. The majority of the patients examined had caries.

Инфекционные заболевания у пациентов с сахарным диабетом: обзор литературы

Diabetes mellitus is associated with increased susceptibility to infectious diseases. This is due to the fact that uncontrolled hyperglycemia is accompanied by impaired innate and adaptive immune response, micro- and macroangiopathies, neuropathy, and decreased urine antibacterial activity. Furthermore, complications of diabetes mellitus such as neuropathy and peripheral vascular disease can lead to skin ulceration with secondary bacterial infections. Bacteria can invade any organ of the human body, with the most common foci of infection in diabetes mellitus being the urinary tract, respiratory tract, skin, and soft tissues. Some infectious diseases are specific to patients with diabetes mellitus, such as malignant external otitis media, foot infections, and nasopharyngeal mucormycosis. Infectious processes may be the first manifestations of diabetes mellitus or provoking factors for inherent complications such as diabetic ketoacidosis and hypoglycemia. Glucose control can be an alternative tool in infection control not only in patients with diabetes mellitus. In addition, controlling hyperglycemia offers the potential to improve the outcome of some infectious diseases.

Oral foci of infection in pediatric population during COVID-19 omicron pandemic era.

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study is to assess the prevalence of oral foci of infection in a multispeciality hospital during pandemic in Chennai, South India. Majority of the patients examined had caries.

Added value of non-contrast CT for the diagnosis of acute pyelonephritis in older patients with suspected infection with an unknown focus: a retrospective diagnostic study

ObjectivesIn older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis...

Clinical and Microbiological Characteristics of ST72 Methicillin-Susceptible Staphylococcus aureus: Comparison with ST72 Methicillin-Resistant S. aureus.

Sequence type 72 (ST72) is the predominant community-associated methicillin-resistant Staphylococcus aureus (MRSA) genotype in Korea. With an increasing prevalence of the ST72 S. aureus lineage, regardless of methicillin resistance, it is crucial to understand the clinical and microbiological characteristics of ST72 methicillin-susceptible S. aureus (MSSA) as well as ST72 MRSA. In this retrospective cohort study, data from patients with S. aureus bacteremia (SAB) who were admitted to a tertiary hospital in Korea from March 2007 to December 2018 were collected. Multilocus sequence typing was used to identify ST72 isolates. The clinical and microbiological characteristics of ST72 MSSA were compared with those of ST72 MRSA among patients infected with SAB. Among the 442 SAB patients with ST72, 157 (35.5%) were infected with MSSA and 285 (64.5%) were infected with MRSA. There was a significant increase in the proportion of ST72 MSSA in both the community and hospital settings. Compared to ST72 MRSA, ST72 MSSA isolates were less likely to have multidrug resistance. The main infection foci, infection severity, and duration of bacteremia did not differ significantly between the two groups. The 90-day recurrence rate was significantly lower in the MSSA group (2.5% vs. 8.4%, P=0.03), while the 90-day mortality rate was comparable (28.0% vs. 23.9%, P=0.40). ST72 MSSA had similar clinical features as ST72 MRSA in terms of infection site, severity, and 90-day mortality. Despite exhibiting lower levels of antibiotic resistance, ST72 MSSA has increased in the hospital environment concurrently with ST72 MRSA.

Vitreoretinal complications of uveitis: The role of vitrectomy

The scope of vitreoretinal intervention in patients with uveitis has recently expanded. Therapeutic vitrectomy is performed to address complications such as visual loss from vitreous opacities, retinal detachment, development of epiretinal membranes, hypotony and in certain cases to remove confined infective foci and assist in sustained drug delivery and diagnosis.While a plethora of studies report favourable outcomes of PPV in the management of uveitis, the quality of data remains poor, with a paucity of standardized reporting and limited prospective data.We will discuss our own experience and review the literature on each of the above surgical indications.

Adaptation of epizootic brucella strains to the conditions of artificial nutrient media and the body of experimentally infected animals

Brucellosis remains an urgent problem to date. The preservation of brucellosis infection foci in regions with traditionally developed animal husbandry poses a danger of introducing the pathogen into safe territories, spreading among susceptible livestock and the risk of human infection. When fresh foci of brucellosis occur in an area with long-term well-being, objective data on the causative agent of infection are of great importance. The purpose of the research is to obtain an objective result of laboratory studies when diagnosing brucellosis in cattle in a fresh outbreak of infection and to evaluate the effectiveness of a set of diagnostic methods used in the work. The research was carried out in production veterinary and scientific laboratories. It was found that brucella, forming a fresh source of infection in cattle herds against the background of long-term well-being, had active antigenic properties. In 42% of infected animals (5 out of 12 animals), brucella of the epizootic strain caused the synthesis of specific immunoglobulins. Isolated brucella cultures were characterized by a weakly expressed ability to adapt to the conditions of an artificial nutrient medium and the body of laboratory animals. In the conducted studies, the probability of isolating the causative agent of brucellosis from animals that respond positively to serological examination was 20%. The objective data obtained on the properties of brucellosis pathogens circulating among susceptible animals in a fresh outbreak of infection made it possible to determine its species differences; establish factors and ways of introducing brucella, predict the course of infectious and epizootic processes, make a timely decision on carrying out health and preventive measures using effective methods and means.

Clinical and genomic characterization of carbapenem-resistant Enterobacterales bloodstream infections in patients with hematologic malignancies.

Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) pose a significant risk to patients with hematologic malignancies, yet the distinct features and outcomes of these infections are not thoroughly understood. This retrospective study examined the characteristics and clinical outcomes of patients with Enterobacterales BSIs at the Hematology Department of Fujian Medical University Union Hospital from 2018 to 2022. Whole-genome sequencing was conducted on 45 consecutive CRE BSI isolates during this period. A total of 301 patients with Enterobacterales BSIs were included, with 65 (21.6%) cases of CRE and 236 (78.4%) cases of carbapenem-susceptible Enterobacterales (CSE). CRE infections accounted for 16.9% to 26.9% of all Enterobacterales BSIs, and carbapenem-resistant Klebsiella pneumoniae (CRKP) was the predominant strain. The most frequent sequence type (ST) and carbapenemase among CRKP were ST11 (68.6%) and blaKPC-2 (80.0%), respectively. Perianal infections, multiple infection foci, and a history of multiple hospitalizations, ICU stays, and prior CRE infections were identified as risk factors for CRE BSIs. Patients in the CRE group experienced significantly higher proportions of infection-related septic shock (43.1% vs. 19.9%, P < 0.0003) and 30-day all-cause mortality (56.9% vs. 24.6%, P < 0.0001) compared to those in the CSE group. Patient's age and disease subtypes, strain subtypes, and antimicrobial treatment regimens significantly influenced survival in patients with CRE BSIs. CRE BSIs are a frequent complication in patients with hematological malignancies undergoing treatment and are associated with poor survival rates. A comprehensive understanding of risk factors and ongoing surveillance of prevalent strains are essential for the effective management of these infections.

Extended-spectrum beta-lactamase-producing Enterobacterales in patients with suspected sepsis in an acute care setting in Skåne, Sweden: a cohort study

Introduction Epidemiological data on extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales are most often based on microbiological laboratory isolates and do not consider important clinical data such as infection or colonisation, treatment, and outcome. This study aimed to assess prevalence of ESBL-producing Enterobacterales as the cause of infection in patients with suspected sepsis in the emergency department based on clinical data. It also examined the number of patients with suspected sepsis who had ESBL-producing pathogens, comparing estimates that were based on laboratory data versus a combination of laboratory and clinical data. Methods Patients with suspected sepsis in the emergency department at Skåne University Hospital, Lund, Sweden were included consecutively. Data were collected retrospectively from medical records. Results Of the 764 included patients, 223 patients had growth of Enterobacterales in any specimen (i.e. colonisation or infection according to laboratory data), while 191 patients had Enterobacterales detected in the blood or in the suspected focus of infection (i.e. an infection according to clinical and laboratory data). Eighteen patients had ESBL-producing Enterobacterales in any clinical specimen, 11 of whom had an infection with ESBL-producing Enterobacterales, resulting in a prevalence of infections with ESBL-producing Enterobacterales in infected patients with suspected sepsis of 1.8%. The number of patients with ESBL-producing Enterobacterales was not significantly different when infection was defined using laboratory data alone versus a combination of laboratory and clinical data [18/223 (8.1%) vs 11/191 (5.8%), p = 0.36]. Conclusions The prevalence of ESBL-producing Enterobacterales infections among patients with suspected sepsis is low in an acute care setting in Sweden.

A point-of-care aptasensor based on the upconversion nanoparticles/MoS2 FRET system for the detection of Pseudomonas aeruginosa infection.

The rapid detection of Pseudomonas aeruginosa (P. aeruginosa) is of great significance for the diagnosis of medical infection. In view of the above, a novel aptasensor based on fluorescence resonance energy transfer (FRET) was developed. It contained aptamer-coupled upconversion nanoparticles (UCNPs-apt) as a donor (excitation 980nm) and molybdenum disulfide (MoS2) nanosheets as an acceptor. The upconversion fluorescence aptamer system was investigated to obtain the optimal parameters of MoS2 concentration, the incubation time of UCNPs-apt/MoS2 and P. aeruginosa, and pH. Based on the optimal parameters, a linear calibrationequation (emission 654nm) with a wide detection range 8.7 × 10 ~ 8.7 × 107cfu/mL, a high coefficient of determination R2 0.9941, and a low limit of determination (LOD) 15.5cfu/mL were established. The method was validated with P. aeruginosa infected foci of mouse wound. The advantage of this aptasensor isthat analysisresults can be obtained within 1.5h, which was much faster than that ofthe standard method (18-24h). Furthermore, combined with a portable instrument, it can be used as a point-of-care testing for the early detection of P. aeruginosa infection, which is useful for selecting the correct antibiotics to achieve good therapeutic effects. Additionally, it also has a broad application prospect in food and environmental areas.

Periprosthetic Knee and Hip Infection — Is It Possible to Compare Treatment Outcomes?

Background. It is known that the outcomes of patients treatment with periprosthetic joint infection (PJI) are significantly influenced by the state of the patient’s body, the nature of the pathogen, the state of tissues in the area of the infectious focus and the treatment tactics. However, topographic and anatomical features of the blood supply to the knee and hip joints, as well as the volume of soft tissues, can affect the spectrum of pathogens, manifestations of the infectious process and, as a consequence, the effectiveness of treatment.&#x0D; The aim of the study was to conduct a comparative analysis of the somatic status of patients, the etiology of the infectious process and the effectiveness of treatment of PJI depending on its localization.&#x0D; Methods. A single-center retrospective study was conducted. The cases of 337 patients were studied — 119 patients with knee and 218 patients with hip PJI who underwent treatment with a two-stage technique during the period from 2007 to 2017. A comparative analysis of the PJI pathogens structure and concomitant pathology between patients with hip and knee PJI was carried out. The frequency of infection relief in the groups following the first stage was counted.&#x0D; Results. Recurrence was diagnosed four times more frequently in patients with hip PJI compared to knee PJI. Risk factors for recurrence were gram-negative pathogens, microbial associations, and fistulous forms of the infectious process. Localization of the infectious process in the hip area was associated with a statistically significant greater volume of blood loss during the prolonged debridement surgery.&#x0D; Conclusion. Recurrences of PJI occur more frequently in the hip area compared to the knee joint. Further analysis of critical factors in recurrence development is necessary for potential intervention.

Postbiotic Activities of Bifidobacterium adolescentis: Impacts on Viability, Structural Integrity, and Cell Death Markers in Human Intestinal C2BBe1 Cells.

Acute diarrheal disease (ADD) caused by rotavirus (RV) contributes significantly to morbidity and mortality in children under five years of age. Currently, there are no specific drugs for the treatment of RV infections. Previously, we reported the anti-rotaviral activity of the protein metabolites derived from Bifidobacterium adolescentis. In this study, our aim was to assess the impact of B. adolescentis-secreted proteins (BaSP), with anti-rotaviral activity on the human intestinal C2BBe1 cell line. We initiated the production of BaSP and subsequently confirmed its anti-rotaviral activity by counting the infectious foci using immunocytochemistry. We then exposed the C2BBe1 cells to various concentrations of BaSP (≤250 µg/mL) for 72 h. Cell viability was assessed using the MTT assay, cell monolayer integrity was monitored through transepithelial electrical resistance (TEER), and cytoskeleton architecture and tight junctions (TJs) were examined using confocal microscopy with F-actin and occludin staining. Finally, we utilized a commercial kit to detect markers of apoptosis and necrosis after 24 h of treatment. The results demonstrated that BaSP does not have adverse effects on C2BBe1 cells. These findings confirm that BaSP inhibits rotavirus infectivity and has the potential to strengthen intestinal defense against viral and bacterial infections via the paracellular route.

Cerebral Abscess In A Child With Unknown Origin Of Infection

Introduction: The incidence of brain abscesses is higher in developing countries. The classic triad of fever, headache, and focal neurological signs was seen in 9–28% of the pediatric cases. Brain abscesses occur infrequently with potentially life-threatening conditions. Case Report: The patient was a child 1 year 8 months old with a main complaint of weakness in the left arm and leg progressively for one month. She had a local seizure on her left arm and leg one month before admission with a duration of 30 minutes. She was irritable for the last two weeks. The strength of the upper and lower extremities was 3 respectively. The physiology reflex was hyper-reflex on the upper and lower extremities. A Head non-contrast CT scan showed a hypodense lesion on the right parietal with a perifocal edema lesion. A head contrast CT scan showed a hypodense lesion on the right parietal with ring enhancement measuring approximately 6,2 cm x 4,5 cm. Craniotomy evacuation abscess with near total capsulectomy was done on initial and capsule resection was done. Discussion: Brain abscess is a focal pyogenic infection of the brain parenchyma, and the frontotemporal lobe is the most common site of brain abscess, followed by frontal-parietal, parietal, occipital lobes, and cerebellar. The most common risk factors that predispose a child to the formation of a brain abscess include congenital heart disease, sinus and otogenic infections, and poor dental hygiene. The triad of brain abscess, including headache, fever, and neurological symptoms is only present in (15%) of the cases reported. Medical treatment is recommended in patients without increased intracranial pressure, with symptoms of less than 1 week long and abscess of less than 2 cm seen in tomography. The suggested time of treatment is between 6 and 8 weeks with intravenously administered antibiotics. A full recovery rate from the infection of about 60–70% is reported in the case of early diagnosis and proper therapy Conclusion: Cerebral abscess in pediatrics with unknown origin of infection may happen in 12%. Early diagnosis and treatment of pediatric cerebral abscesses can reduce morbidity and mortality rates. A broadspectrum antibiotic is an optimal treatment in the postoperative evacuation of cerebral abscess cases with unknown origin infection.

The usefulness of lactate/albumin ratio, C-reactive protein/albumin ratio, procalcitonin/albumin ratio, SOFA, and qSOFA in predicting the prognosis of patients with sepsis who presented to EDs

PurposeEarly identification of sepsis with a poor prognosis in the emergency department (ED) is crucial for prompt management and improved outcomes. This study aimed to examine the predictive value of sequential organ failure assessment (SOFA), quick SOFA (qSOFA), lactate to albumin ratio (LAR), C-reactive protein to albumin ratio (CAR), and procalcitonin to albumin ratio (PAR), obtained in the ED, as predictors for 28-day mortality in patients with sepsis and septic shock. Materials and methodsWe included 3499 patients (aged ≥19 years) from multicenter registry of the Korean Shock Society between October 2015 and December 2019. The SOFA score, qSOFA score, and lactate level at the time of registry enrollment were used. Albumin, C-reactive protein, and procalcitonin levels were obtained from the initial laboratory results measured upon ED arrival. We evaluated the predictive accuracy for 28-day mortality using the area under the receiver operating characteristic (AUROC) curve. A multivariable logistic regression analysis of the independent predictors of 28-day mortality was performed. The SOFA score, LAR, CAR, and PAR were converted to categorical variables using Youden's index and analyzed. Adjusting for confounding factors such as age, sex, comorbidities, and infection focus, adjusted odds ratios (aOR) were calculated. ResultsOf the 3499 patients, 2707 (77.4%) were survivors, whereas 792 (22.6%) were non-survivors. The median age of the patients was 70 (25th–75th percentiles, 61–78), and 2042 (58.4%) were male. LAR for predicting 28-day mortality had the highest AUROC, followed by the SOFA score (0.715; 95% confidence interval (CI): 0.69–0.74 and 0.669; 95% CI: 0.65–0.69, respectively). The multivariable logistic regression analysis revealed that the aOR of LAR >1.52 was 3.75 (95% CI: 3.16–4.45), and the aOR, of SOFA score at enrollment >7.5 was 2.67 (95% CI: 2.25–3.17). ConclusionThe results of this study showed that LAR is a relatively strong predictor of sepsis prognosis in the ED setting, indicating its potential as a straightforward and practical prognostic factor. This finding may assist healthcare providers in the ED by providing them with tools to risk-stratify patients and predict their mortality.

The possibility of phenotyping patients with sepsis in a chronic critical condition

The main obstacle to understanding sepsis is an excessively broad definition of this disease, which covers an extensive set of clinical and pathophysiological signs. Different combinations of these traits can naturally combine into phenotypes that have different degrees of risk of an adverse outcome, and may respond differently to treatment. Scientific work on the determination of phenotypes has focused mainly on patients in the intensive care unit. In addition, there have been no prospective or retrospective studies on the classification and phenotyping of sepsis patients in a chronic critical condition. Most likely, this is due to the fact that the term «chronic critical patient» is quite novel and has recently been widely covered in both Russian and foreign scientific literature. The purpose of this work is the theoretical determination of phenotypic groups for chronic critical patients. Methods and materials: The search for Russian publications was carried out in the database on the RSCI website, and foreign publications were searched in the PubMed and Google Scholar databases in the period of 1998–2022. When analyzing the PubMed database, the query «sepsis phenotype» resulted in 62,371 links. The works on the keywords «chronic critical illness» were also studied. The publications describing the sepsis phenotypes, the diagnosis of sepsis and septic shock, as well as the clinical picture of a chronic critical condition (illness) were analyzed, with a total of 45 scientific articles. Discussion: It is also worth noting that the study by C. Seymour, latent class analysis, and other works devoted to the treatment of sepsis consider a large number of mainly non-surgical patients, without dividing them by the main nosology and foci of infection. Meanwhile, the main axis of neurohumoral immunity, i.e. the brain — gastrointestinal tract, is disrupted in chronic critical patients. These patients, as well as patients undergoing repeated sepsis caused by a nosocomial infection, are not considered separately in any of the studies. Furthermore, neither the study by C. Seymour, nor the latent class analysis examines any instrumental method for assessing the infection focus (radiography or computed tomography of the lungs). Much attention is paid to the acid-base state of patients, but the state of the main buffer systems is not described in terms of the presence of concomitant or competing diseases, and an indication of an increase in creatinine and blood urea nitrogen can only indirectly indicate kidney dysfunction and, as a consequence, a disorder in the bicarbonate bufer system. Conclusions: Based on the above, the basic classifications for patients with sepsis in an acute state should be updated for chronic critical patients with host response options, taking into account the peculiarities of the immune system. Moreover, it is recommendable to phenotype chronic critical patients separately, considering the localization of brain damage, since patients with vertebrobasilar lesions are more prone to aspiration pneumonia and severe sepsis, while this type of pneumonia is extremely rare in patients with frontal lobe lesions. Accordingly, hypothalamic lesion leads to a change in the neurohumoral immune response to various pathogens. Thus, chronic critical patients with sepsis should be classified not only according to already known phenotyping systems, but also based on the localization of brain damage and the functionality of the gastrointestinal tract.