Beta-lactamase activity is a biomarker for the prediction of the efficacy of antimicrobial therapy.

<b>Objective:</b> To evaluate the state of beta-lactamase activity (BLA) in biological fluids in patients with infectious exacerbation of respiratory pathology. <b>Methods and Materials:</b> The level of BLA of blood serum was determined in 95 patients with exacerbation of COPD (55 patients) and community-acquired pneumonia (40 patients) using the "BioLactam" test system (BLR) on the background of comprehensive clinical and laboratory and instrumental examination, characterizing the severity of the disease course. <b>Outcomes.</b> The level of blood serum BLA is determined by phenotypic and clinical variables such as age over 60 y, severe respiratory pathology, temperature elevation above 38.0°C, peripheral blood leukocyte count above 10x109/L, C-reactive protein greater than 40 mg/L, and saturation less than 93%, which are correlated with increased BLA levels and predict low efficacy of BLAs treatment. A direct correlation was found between the level of blood serum BLA and the duration of antimicrobial therapy within a year (r=+0.86, p=0.001), the number of AMPs concurrently prescribed (r=+0.69, p=0.001), receipt of beta-lactam reserve antibiotics such as cefepime, imipenem, meropenem (r=+0.71, p=0.001), and prescription of non-beta-lactam reserve antibiotics such as rifampin, azithromycin, vankomycin, linezolid, levofloxacin (r=+0.59, p=0.001). <b>Conclusion:</b> The conclusion argues for the necessity of determining the level of beta-lactamase activity in biological substrates in order to predict the efficacy of successful treatment with first-line BLA within the framework of evidence-based medicine. The evaluation of the BLA level will allow for a reduction of up to 30% in the unjustified use of BLAs.

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