New method for analysing spatial relationships of facial muscles on MRI: a pilot study.

Dysfunction of the facial musculature can have significant physical, social, and psychological consequences. In surgeries such as cleft surgery or craniofacial bimaxillary osteotomies, the perioral facial muscles may be detached or severed, potentially altering their functional vectors and mimicry capabilities. Ensuring correct reconstruction and maintenance of anatomical sites and muscle vectors is crucial in these procedures. However, a standardized method for perioperative assessment of the facial musculature and function is currently lacking. The aim of this study was to develop a workflow to analyse the three-dimensional vectors of the facial musculature using magnetic resonance imaging (MRI) scans. A protocol for localizing the origins and insertions of these muscles was established. The protocol was implemented using the 3DMedX computer program and tested on 7 Tesla MRI scans obtained from 10 healthy volunteers. Inter- and intra-observer variability were assessed to validate the protocol. The absolute intra-observer variability was 2.6 mm (standard deviation 2.0 mm), and absolute inter-observer variability was 2.6 mm (standard deviation 1.5 mm). This study presents a reliable and reproducible method for analysing the spatial relationships and functional significance of the facial muscles. The workflow developed facilitates perioperative assessment of the facial musculature, potentially aiding clinicians in surgical planning and potentially enhancing the outcomes of midface surgery.

Isotopic Control of the Boron-Vacancy Spin Defect in Hexagonal Boron Nitride.

We report on electron spin resonance (ESR) spectroscopy of boron-vacancy (V_{B}^{-}) centers hosted in isotopically engineered hexagonal boron nitride (hBN) crystals. We first show that isotopic purification of hBN with ^{15}N yields a simplified and well-resolved hyperfine structure of V_{B}^{-} centers, while purification with ^{10}B leads to narrower ESR linewidths. These results establish isotopically purified h^{10}B^{15}N crystals as the optimal host material for future use of V_{B}^{-} spin defects in quantum technologies. Capitalizing on these findings, we then demonstrate optically induced polarization of ^{15}N nuclei in h^{10}B^{15}N, whose mechanism relies on electron-nuclear spin mixing in the V_{B}^{-} ground state. This work opens up new prospects for future developments of spin-based quantum sensors and simulators on a two-dimensional material platform.

The average three-dimensional face for different sex and age groups in a Dutch population.

The increasing use of three-dimensional imaging calls for reference models representing large parts of the population. The aim of this prospective study was to create templates depicting facial maturation in the younger age groups. Healthy Dutch volunteers were captured, without selection of inclusions. Three-dimensional average faces were created using MATLAB, for both genders in four age groups (4-8 years, 8-12 years, 12-16 years, and ≥16 years). Variation within the groups was calculated and depicted on an average face with a green to red colour scale, corresponding to standard deviations between 0 and ≥ 3 mm, respectively. Measurements of the distances of eight peri-oral landmarks were provided as ratios. The statistical analysis was performed using ANOVA and Tukey's test. Three-dimensional reconstructions of the average face and their first principal component were created for each gender and age group. The first principal component comprised the facial width for each group, and the variation of landmarks was low. All ratios showed an increasing trend with increasing age, except for the ratio of philtrum width to mouth width. This study is novel in comparing facial morphology by means of ratios and in creating average faces for the different young age groups. These data provide useful insights into facial maturation, which might be beneficial for facial surgeons.

Locking in trochanteric fractures: a comparison of static versus dynamic locking using the Gamma3 nail.

PURPOSE: The Gamma3 nail (Stryker®) is an intramedullary device consisting of a proximal lag screw and distal interlocking screw. It is still unknown whether the screw locking mode could influence clinical outcomes. The aim of this study is to compare static and dynamic screw locking regarding their influence on surgical revisions and lag screw displacement. METHODS: A retrospective single-centre study was performed on patients ≥ 60 years admitted for a trochanteric fracture between September 2016 and January 2020. Surgical revisions and lag screw displacement were evaluated at 6 weeks and 1-year follow-up, respectively. RESULTS: A total of 142 patients were included for analysis. Surgical revisions were needed in 13 cases (9.2%). Indications included implant breakage (n = 3), lag screw cut-out (n = 3), lateral hip pain (n = 6) and non-union (n = 1). The number of surgical revisions was not different between static and dynamic locking (OR 2.55; 95%CI 0.73-8.56; p 0.142). The median lag screw displacement was 2.5 mm, which was similar for static and dynamic locking (2.3 mm versus 2.7 mm; p 0.785). CONCLUSION: The screw locking mode of the Gamma3 nail is not associated with a higher risk of surgical revisions. However, the design of the Gamma3 nail may not be suitable for static locking.

[The unresolved contest between MTA and IRM as apical barrier material in apicoectomies. A retrospective cohort study]. / De onbesliste strijd tussen MTA en IRM bij apexresecties ­ een retrospectief cohort­onderzoek.

When endodontic treatment of periapical infection does not suffice, apicoectomy might be the next treatment of choice. Years of treatment development have optimised it as far as possible, but the optimal apical barrier material has still not been indicated. Does MTA as an apical barrier material in apicoectomies effectuate a higher success rate than IRM? A retrospective cohort study analysed all patients who underwent an apicoectomy between 2015 and 2020. Patients for whom the apical barrier material had not been registered, or who were treated by a resident, were excluded. Patients were retrospectively allocated to either the MTA or IRM group. A total of 1,347 treatments were analysed, with an overall success rate of 71%. The MTA group had a success rate of 71%, and the IRM group had a success rate of 70% (p = 0.794). The study revealed that the success rate of apicoectomies was 71%, regardless of the type of material used as the apical barrier. Hence, the use of either material is justified.

Facial nerve palsy due to a parotid abscess: Two case reports and a review of literature.

INTRODUCTION AND IMPORTANCE: Parotid gland swelling with facial nerve palsy is highly suggestive of a malignancy. Facial nerve palsy is however rarely caused by a parotid abscess. We hereby present two cases, propose treatment and present a review of the literature. CASE PRESENTATION AND CLINICAL DISCUSSION: One 75-year-old female and one 81-year-old female presented with a facial nerve paralysis, both caused by a parotid gland abscess. Broad-spectrum antibiotics and incision and drainage was commenced in both cases. Both patients showed good clinical improvement, however, without facial nerve improvement. Magnetic resonance imaging (MRI) scans showed no malignancies at presentation nor during follow-up after one year. CONCLUSION: Facial nerve palsy is rarely caused by a parotid abscess. Incision and drainage in combination with antibiotic treatment is recommended. Chances of facial nerve recovery seem somewhat higher in patients with facial nerve paresis than those with a paralysis.

Microfluidic approach for controlled ultraviolet treatment of colored and fluorescent dissolved organic matter.

Using microfluidic systems to address the optical properties of Colored and Fluorescent Dissolved Organic Matter (CDOM/FDOM) offers new ways for researching its interactions with the environment, and its response to rapid, as well as extreme, changes of abiotic conditions. Here we present a microfluidic device with an Ultraviolet (UV) component. The manufactured microfluidic device consists of passing a dissolved organic matter sample through a microchannel applying a combination of treatments using different UV wavelengths and exposure times. Here we test the workability of the microdevice by analyzing the effect of UV light on CDOM and FDOM, using as irradiations UVA and UVB to incite photodegradation, over different times. We then compare the absorbance and fluorescence, measured from both treated and non-treated samples. The analysis of the measurements is done by the calculation of the slope ratio, as indicative of molecular weight and dissolved organic carbon, besides the fluorescence humification index (HIX) as an overview of the difference between treated and non-treated of the excitation-emission matrices (EEMs). Our results show the efficiency of the microdevice by demonstrating a direct relation of degradation degree with exposure time. FDOM exposure to UVB shows a possible relation to humic-like fluorophores intensity, shown in HIX and the overview difference. Furthermore, the changes showed in the slope ratio demonstrate photodegradation in all treatments, with UVB exhibiting an increased influence. The combination of microfluidic sample treatment within in situ applications of optical sensors will enhance our capacities in addressing biogeochemical processes in the marine environment, which were not accessible with conventional bulk methods.

Impact of dental clearance on total joint arthroplasty: A systematic review.

Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty (TJA). However, there is no consensus substantiating the practice. To this end, a systematic review on the prevalence of dental pathology in TJA patients, risk factors for failing dental screening, and impact of dental evaluations was performed. Literature was sourced from PubMed and Scopus databases. Six papers were sourced from the initial search, one study was extracted from the references of the original six manuscripts, and one new publication was retrieved from a second search conducted after the first. The prevalence of dental pathology ranged from 8.8% to 29.4% across studies. Two of four papers reported lower than average or improvements in post-operative infection with pre-operative dental evaluations while two found no such association. There is insufficient evidence to support universal dental clearance before TJA.

Clinical Results of Direct Anterior Approach THA with Minimal Fluoroscopic Exposure Optimization Techniques.

PURPOSE: To determine if low-level intraoperative fluoroscopy usage is associated with increased complications during an initial series for an experienced surgeon transitioning to direct anterior approach (DAA) for total hip arthroplasty (THA). MATERIALS AND METHODS: Subjects who underwent DAA were eligible for analysis. Inclusion criteria included the first 50 subjects who underwent DA hip arthroplasty by a single surgeon (January 2013 to December 2014). Total operating room (OR) time, fluoroscopy absorbed dose, flouoroscopy time, procedure time, and complications were collected and analyzed. Subject demographics were also collected with subjects divided by date of surgery to one of two possible groups. Simple linear regression analysis was performed to determine the relation between case number and both radiation dose and fluoroscopy time. RESULTS: Subjects underwent DAA total hip arthroplasty (n=45). Total OR time ranged from 1.1hrs up to 2.5 hours. Surgeries required an average fluoroscopic time of 7.8 seconds, with improvement over the series of 3.7 seconds. The average radiation dose or fluoroscopy was 2.6 mrem per case. This resulted in a total estimated exposure of 127 mrem over a 23-month period. No patients suffered intraoperative or postoperative fractures or revisions. No significant difference was found for the groups by weight, age, height, and body mass index. Regression analysis yielded a statistically significant (p<0.05) decrease in fluoroscopy time of 0.36 seconds per case over the 45 cases studied. CONCLUSION: An experienced single surgeon's learning curve in DAA THA can be accelerated, with proper training and technique, within a lifetime case experience less than 50 procedures. Surgeons should be aware that with proper techniques and sufficiently-experienced teams, a flattened learning curve is attainable while minimizing fluoroscopy exposure and maintaining clinical outcomes.

[Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. / Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie ­ Update 2017.

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.

Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use.

BACKGROUND: Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS. METHODS: 58 patients undergoing unilateral TKA were randomly assigned to receive 4 20-min sessions (a total of 80 min) of tDCS (2 mA) post-surgery with electrodes placed to create 4 groups: 1) MOTOR (n = 14); anode-motor/cathode-right prefrontal, 2) PREFRONTAL (n = 16); anode-left-prefrontal/cathode-right-sensory, 3) ACTIVE-CONTROL (n = 15); anode-left-temporal-occipital junction/cathode-medial-anterior-premotor-area, and 4) SHAM (n = 13); 0 mA-current stimulation using placements 1 or 2. Patient controlled analgesia (PCA; hydromorphone) use was tracked during the ∼72-h post-surgery. RESULTS: Patients in the sham group and the active-control group used 15.4 mg (SD = 14.1) and 16.0 mg (SD = 9.7) of PCA hydromorphone respectively. There was no difference between the slopes of the cumulative PCA usage curves between these two groups (p = 0.25; ns). Patients in the prefrontal tDCS group used an average of 11.7 mg (SD = 5.0) of PCA hydromporhone, and the slope of the cumulative PCA usage curve was significantly lower than sham (p < 0.0001). However, patients in the motor tDCS group used an average of 19.6 mg (SD = 11.9) hydromorphone and the slope of the PCA use curve was significantly higher than sham (p < 0.0001). CONCLUSIONS: Results from this double-blind cortical-target-optimization study suggest that anodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex may be a reasonable approach to reducing post-TKA opioid requirements. Given the unexpected finding that motor cortex failed to produce an opioid sparing effect in this follow-up trial, further research in the area of post-operative cortical stimulation is still needed.

Bacterial aetiology and mortality in COPD patients with CAP: results from the German Competence Network, CAPNETZ.

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. OBJECTIVES: 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. METHODS: Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. RESULTS: Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P < 0.001). The number given adequate empirical antibiotic treatment was comparable (83.3% CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P < 0.001). Partial pressure of arterial carbon dioxide levels were increased in CAP-COPD patients without pathogen detection (P < 0.001). Short- (P = 0.011) and long-term mortality (P = 0.006) were highest in CAP-COPD without pathogen detection. CONCLUSION: It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.

[Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. / Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention - Update 2016.

The present guideline provides a new and updated concept of treatment and prevention of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2009.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment as well as primary and secondary prevention.

Assessment of oxygenation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score.

BACKGROUND: Addition of assessment of comorbid diseases ('D') and oxygen saturation ('S') to the CRB-65 score has been recommended to improve its accuracy for risk stratification in community-acquired pneumonia (CAP). The aim of this study was to validate the resulting DS-CRB-65 score in a large cohort of patients with CAP. METHODS: A total of 4432 patients prospectively enrolled in the CAPNETZ cohort were included in this study. Predefined end points were 28-day mortality, requirement for mechanical ventilation or vasopressors (MV/VS) and requirement for MV/VS or intensive care unit admission (MV/VS/ICU). Receiver operating characteristic curve analysis was used to determine the accuracy of the CRB-65 score and the addition of D (extra-pulmonary comorbidities) and S (oxygen saturation <90% or partial pressure of oxygen <8 kPa). Binary logistic regression and the method of Hanley and McNeil were used to compare the criteria. RESULTS: The mortality rate was 4.0%, and 4.2% of patients required MV/VS and 6.6% required MV/VS/ICU. After multivariate analysis, D and S independently were added to the CRB-65 criteria for mortality prediction, but only S improved prediction of MV/VS and MV/VS/ICU (P < 0.001 for all). The area under the curve of the CRB-65 score was significantly improved by adding D and S for all end points (P < 0.02). Amongst patients who died or required MV/VS despite a CRB-65 score of 0, 64-80% would have been identified by the DS-CRB-65 score. CONCLUSIONS: The addition of assessment of oxygenation and comorbidities significantly improved the prognostic accuracy of the CRB-65 score. Consequently, the DS-CRB-65 score may have a useful role in risk stratification algorithms for CAP.

Complications of hip and knee joint replacement in solid-organ transplant patients.

This study investigated complication rates for 68 solid-organ transplant patients who had undergone 94 primary hip or knee joint replacements at a single institution from 1995 to 2008. There was a deep infection rate of 6.8% in the transplant patients compared to a 1.9% deep infection rate for all primary joint replacement patients at the Medical University of South Carolina over the same time period (odds ratio 4.48). All four infections in the transplant group occurred in diabetic patients. The joint revision rate for transplant patients was 13% (deep infection 6.8%, aseptic loosening 5.1%, instability 1.7%). Other complications included superficial infections (5.1%), deep venous thromboses (3.4%), and a nonfatal pulmonary embolus (1.7%). The deep infection rate for joint replacement in solid-organ transplant patients was higher than rates reported by most similar studies, and diabetic patients may be at particular risk.

[Ventilator-associated pneumonia]. / Ventilatorassoziierte Pneumonie.

Ventilator-associated pneumonia (VAP) is a severe, not entirely preventable complication of invasive ventilation. Timely and adequate antibiotic treatment is important; therefore, intensivists often initiate broad spectrum antibiotic regimens upon clinical suspicion of VAP. Criteria for the diagnosis of VAP are not perfect and a clear distinction of VAP from ventilator-associated tracheobronchitis is not always possible due to the limitations of chest x-rays in ventilated patients. The attributable mortality of VAP is likely overestimated. All these aspects increase the need to reevaluate the diagnosis of VAP on a daily basis. Microbiology data are helpful in the decision to de-escalate or stop antibiotics. The prudent use of antibiotics and implementation of a number of preventive measures are key for management of VAP in ICUs. These steps will help to minimize the development of multidrug-resistant pathogens and, in turn, may help guarantee more antibiotic options for future patients.

The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions.

STUDY OBJECTIVE: To determine whether an automated intermittent bolus technique provides enhanced analgesia compared with a continuous infusion for femoral nerve block. DESIGN: Prospective, single-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT01226927). SETTING: Perioperative areas and orthopedic surgical ward of a university hospital. PATIENTS: 45 ASA physical status 1, 2, and 3 patients undergoing unilateral primary total knee arthroplasty. INTERVENTIONS: All patients received single-injection sciatic and femoral nerve blocks plus femoral nerve catheter placement for postoperative analgesia. Patients were randomly assigned to an automated intermittent bolus (5 mL every 30 min with 0.1 mL/hr basal rate) or a continuous infusion (10.1 mL/hr) delivery method of 0.2% ropivacaine. MEASUREMENTS: Consumption of intravenous patient-controlled analgesia (IV-PCA) and visual analog scale (VAS) pain scores were assessed postoperatively at set intervals until the morning of postoperative day (POD) 2. MAIN RESULTS: The mean (SEM) cumulative IV-PCA dose (mg of hydromorphone) for the 36-hour postoperative interval measured was 12.9 ± 2.32 in the continuous infusion rate group (n = 20) and 7.8 ± 1.02 in the intermittent bolus group [n = 21, t(39) = 2.04, P = 0.048; a 39 ± 14% difference in total usage]. Pain scores were statistically significantly lower in the intermittent bolus group in the afternoon of POD 1 (t(39) = 2.47, P = 0.018), but were otherwise similar. CONCLUSIONS: An automated intermittent bolus infusion technique for femoral nerve catheters is associated with clinically and statistically significantly less IV-PCA use (ie, an opioid-sparing effect) than a continuous infusion technique.

Growth modulation index as metric of clinical benefit assessment among advanced soft tissue sarcoma patients receiving trabectedin as a salvage therapy.

BACKGROUND: The growth modulation index (GMI) is the ratio of time to progression with the nth line (TTP(n)) of therapy to the TTP(n)(-1) with the n-1th line. GMI >1.33 is considered as a sign of activity in phase II trials. PATIENTS AND METHODS: This retrospective analysis evaluated the concordance between the GMI and the efficacy outcomes in 279 patients with advanced soft tissue sarcoma (ASTS) treated with trabectedin 1.5 mg/m² (24-h infusion every 3 weeks) in four phase II trials. RESULTS: One hundred and forty-two (51%) patients received one prior line and 137 ≥ 2 lines. The median TTP(n) was 2.8 months (range 0.2-26.8), whereas the median TTP(n)(-1) was 4.0 months (0.3-79.5). The median GMI was 0.6 (0.0-14.4). Overall, 177 patients (63%) had a GMI <1; 21 (8%) a GMI equal to 1-1.33 and 81 (29%) a GMI >1.33, which correlated with the median overall survival in those patients (9.1, 13.9 and 23.8 months, respectively, P = 0.0005). A high concordance rate between the GMI and response rate (P < 0.0001) and progression-free survival (PFS, P < 0.0001) was observed. Good performance status (PS) was the only factor associated with GMI >1.33 (PS = 0; P < 0.04). CONCLUSIONS: A high GMI was associated with favorable efficacy outcomes in patients treated with trabectedin. Further research is needed to assess GMI as an indicator in this setting.

[Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]. / Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie. S-3 Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V., der Deutschen Gesellschaft für Infektiologie e.V., der Deutschen Gesellschaft für Hygiene und Mikrobiologie e.V., der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. und der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.

The burden of pneumococcal pneumonia - experience of the German competence network CAPNETZ.

BACKGROUND: Pneumococcal pneumonia is still an important cause of mortality. The objective of this study was to compare frequency, clinical presentation, outcome and vaccination status of patients with pneumococcal community-acquired pneumonia (CAP) to CAP due to other or no detected pathogen based on data of the German Network for community-acquired pneumonia (CAPNETZ). METHODS: Demographic, clinical and diagnostic data were recorded using standardized web-based data acquisition. Standardized microbiological sampling and work-up were conducted in each patient. RESULTS: 7400 patients with CAP from twelve clinical centers throughout Germany were included. In 2259 patients (32 %) a pathogen was identified, Streptococcus pneumonia being the most frequent (n = 676, 30 % of all patients with identified pathogens). Compared to those with non-pneumococcal pneumonia, patients with pneumococcal pneumonia were more frequently admitted to hospital (80 % vs. 66 %, p < 0.001), had higher CURB score values on admission, had more frequently pleural effusion (19 % vs. 14 %, p = 0.001) and needed more frequently oxygen insufflation (58 % vs. 44 %, p < 0.001). There was no relevant difference in overall mortality. CONCLUSIONS: Pneumococcal pneumonia was associated with a more severe clinical course demanding more medical resources as compared to non-pneumococcal pneumonia.