BACKGROUND: Pneumonia is one of the most common indications for antibiotic. Shortening the duration of antibiotic therapy should help reduce bacterial resistance. To date, three randomized control trials have shown non-inferiority of short courses of antibiotic therapy (3 days) compared with 7 days in non-severe pneumonia. The aim of this study was to assess this strategy in real life.
METHODS: This retrospective observational cohort study included all patients with pneumonia hospitalized in an internal medical ward from 11/01/2022 to 05/31/2023. We implemented the strategy based on early discontinuation of antibiotic therapy in patients with pneumonia who were clinically stable after 3 days of β-lactam treatment.
RESULTS: Among 49 patients included, median age was 72, median antibiotic duration was 4 days (IQR 3-6), and cure rate at D30 was 88 %. At day 30, we observed one death (2 %), four new antibiotic therapy (9 %), and two new hospitalisation (5 %), among five immunosuppressed patients. Among immunosuppressed patients (n=17; 35 %), failure rate was three times higher in case of short antibiotic courses (3/8; 38 %) than long antibiotic courses (1/7; 14 %).
CONCLUSIONS: Strategy based on early discontinuation of antibiotic therapy in immunocompetent patients with pneumonia who were clinically stable after 3 days of β-lactam treatment is safe, and easy to implement in a medical ward.

OBJECTIVE: Our aim in this study was to systematically assess the association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs dipeptidyl peptidase-4 inhibitors (DPP4i) with pneumonia, COVID-19, and adverse respiratory events in patients with type 2 diabetes mellitus (DM).
METHODS: PubMed, Embase, and Cochrane Library databases were retrieved to include studies on DM patients receiving SGLT2i (exposure group) or DPP4i (control group). Stata version 15.0 statistical software was used for the meta-analysis.
RESULTS: Ten studies were included, all 10 of which were used for the qualitative review and 7 for the meta-analysis. According to the meta-analysis, patients receiving SGLT2i had a lower incidence of pneumonia (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.51 to 0.74) and pneumonia risk (OR 0.63, 95% CI 0.60 to 0.68, p=0.000) compared with those receiving DPP4i. The same situation was seen for mortality for pneumonia (OR 0.49, 95% CI 0.39 to 0.60) and pneumonia mortality risk (OR 0.47, 95% CI 0.42 to 0.51). There was lower mortality due to COVID-19 (OR 0.31, 95% CI 0.28 to 0.34) and a lower hospitalization rate (OR 0.61, 95% CI 0.56 to 0.68, p=0.000) and incidence of mechanical ventilation (OR 0.69, 95% CI 0.58 to 0.83, p=0.000) due to COVID-19 in patients with type 2 DM receiving SGLT2i. Qualitative analysis results show that SGLT2i were associated with a lower incidence of COVID-19, lower risk of obstructive airway disease events, and lower hospitalization rate of health-care-associated pneumonia than DPP4i.
CONCLUSIONS: In patients with type 2 DM, SGLT2i are associated with a lower risk of pneumonia, COVID-19, and mortality than DPP4i.

BACKGROUND: Data collected by general practitioners (GPs) may provide potential for health services research. In this study, we investigated if clinical questions can be answered with GPs\' electronic medical records (EMRs) by means of diagnosing community-acquired pneumonia (CAP).
METHODS: Patients diagnosed with CAP, defined as ICD code J18.9, were identified in the fourth quarter of 2021. The data were derived from the EMR system (Medical Office®) of a central German association of 30 general practices, using three different approaches: 1. The integrated statistic tool was used to record whether patients were referred for radiological diagnostic confirmation. 2. Retrospectively, EMRs were evaluated manually by a doctor familiar with the EMR. 3. The raw data of the EMR system were extracted by automated export. The information obtained through the three types of access was compared. For each patient case, detailed comments on problems and specifics were documented and evaluated by qualitative content analysis (QCA) according to Mayring.
RESULTS: In total, 164 patients diagnosed with CAP were identified. The numbers of documented radiological diagnostic confirmations varied between data approaches: While the manual evaluation of the EMRs revealed 60 referred patients, the statistics tool identified 38 of these cases. The export of the raw data identified 58 referrals to radiography after adjustment. According to QCA, there was a high variation in applied diagnostics and time of diagnosis. Referrals for radiography were made both before and after coding of the diagnosis. In case of hospitalization, X-rays were usually performed during the inpatient stay. Laboratory tests were performed as an alternative to radiography. There was also a high variation in the documentation of risk factors and diagnostic certainty.
CONCLUSIONS: The statistics tool integrated into the EMR system is a quick way to perform simple queries but proved to be impracticable for complex questions. The EMRs provide detailed information but need to be evaluated manually. An automated data export from the raw data offers both detailed information and access to large volumes of data but requires complex preparation and appropriate IT expertise.
CONCLUSIONS: Based on the example of diagnosed CAP in a GP setting, the use of data extracted from an EMR system seems to be feasible to answer simple clinical questions. However, it is necessary to adapt the data export, and a comparison with a small number of manually evaluated cases is useful to achieve valid results.

Mycobacterium abscessus is a fast-growing non-tuberculous mycobacteria complex causing pulmonary infections, comprising the subspecies abscessus, massiliense and bolletii. Differences are based predominantly on natural inducible macrolide resistance, active in most Mycobacterium abscessus spp abscessus species and in Mycobacterium abscessus spp bolletii but inactive in Mycobacterium abscessus spp massiliense. Therapy consists in long-term treatment, combining multiple antibiotics. Prognosis is poor, as only 40% of patients experience cure. Pharmacodynamic and pharmacokinetic data on M. abscessus have recently been published, showing that therapy ineffectiveness might be explained by intrinsic bacterial resistance (macrolides…) and by the unfavorable pharmacokinetics of the recommended antibiotics. Other molecules and inhaled antibiotics are promising.

OBJECTIVE: Our aim in this study was to determine the reasons for hospitalization in Australian people with diabetes who contract COVID-19.
METHODS: All COVID-19 cases reported to the Victorian Department of Health and linked hospitalization data were assessed. We determined reasons for acute (0 to 30 days) and postacute (31 to 365 days) hospitalization among those with type 1 or type 2 diabetes and COVID-19, compared to those with COVID-19 and no diabetes, and to admissions before the COVID-19 pandemic.
RESULTS: A total of 13,302 Australians with type 1 or type 2 diabetes were hospitalized in the state of Victoria in the 12 months after COVID-19 diagnosis. Respiratory diseases accounted for 40% of acute admissions among those with diabetes. Viral pneumonia was the leading cause of acute hospitalization among those with diabetes and constituted a larger proportion of admissions in those with compared to those without diabetes (adjusted prevalence ratio 1.87, 95% confidence interval 1.76 to 1.99). The distribution of postacute hospitalizations among those with diabetes aligned with that of people with diabetes before the COVID-19 pandemic.
CONCLUSIONS: Respiratory diseases are the leading cause of acute hospitalization in those with type 1 or type 2 diabetes and COVID-19. The reasons for postacute hospitalization resemble those in people with diabetes and no COVID-19. We reinforce the importance of community management of people with diabetes in the ongoing pandemic.

Pulmonary Opacities - What Lies Beneath? Abstract. Abstract: Pulmonary opacities are among the most common findings that general practitioners and internists have to interpret in everyday life. Conventional chest x-rays are still important, but computed tomograms often provide additional information. Patient history, clinical examination but also additionally collected laboratory findings are important prerequisites for the interpretation of imaging studies. Likewise, radiological patterns should be recognized and correctly described. The density, distribution to one or both sides, basal or apical, unifocal or multifocal, also the involvement of the interstitial tissue, bronchioles, the alveolar space and pleura can provide decisive differential diagnostic information. Space-occupying or shrinking processes may be suspected on behalf of the course of pleural lines. Tumours may be differentiated from shrinking lung volume as seen in atelectasis by shift of the mediastinum or the shape of pleural lines. Occasionally control images can support the interpretation of the radiological results.
Zusammenfassung. Zusammenfassung: Lungen-Verschattungen gehören zu den häufigsten Befunden, die Allgemeinpraktiker und Internisten im Alltag interpretieren müssen. Konventionelle Thorax-Röntgenbilder haben weiterhin einen hohen Stellenwert, Computertomogramme liefern aber häufig zusätzliche Informationen. Oft helfen Anamnese und klinische Untersuchung, aber auch zusätzlich erhobene Laborparameter bei der Interpretation. Ebenso sollen radiologische Muster erkannt und beschrieben werden. So können die Dichte, die Verteilung in ein- oder beidseitig, basal oder apikal, uni- oder multifokal, die Lokalisation, der Mitbefall des Interstitiums, der Bronchiolen, der Alveolen, der Pleura entscheidende differenzialdiagnostische Hinweise liefern. Raumfordernde oder schrumpfende Prozesse lassen sich am Verlauf von Pleuralinien oder Shift des Mediastinums vermuten. Gelegentlich helfen Kontrollaufnahmen bei der Interpretation der radiologischen Veränderungen.

No chance for pneumonia - A campaign for mobilization in the context of a practice project addressing pneumonia prevention Abstract. Background: Healthcare-associated infections (HAI) in inpatients are associated with complicated treatment. In Europe, 5.5 % of inpatients develop HAI. About half of these infections could be avoided. In the Clinic for traumatology of the university hospital Zurich, we developed interventions to reduce HAI. Thereby, we focused on non-ventilator-associated hospital-acquired pneumonia (nvHAP). Aim: Besides reducing nvHAP rates, we intended to improve patient mobility, to empower nurses, and to strengthen interprofessional collaboration. Methods: To achieve these aims, we performed a practice development project comprising inhouse training, workshops, information posters, structural changes and a mobilization campaign. Results: Patient mobilization increased by 40 %, duration of mobilization sessions by 46.5 %. The semi-annual comparison shows a sustainable improvement of 7.6 %. Nurses reported knowledge gain, considerably improved interprofessional collaboration and increased quality of caring. Discussion: Combining various methods and following an interprofessional approach resulted in sustainable effects. Limitations and transfer: Targeted practice development proves to be suitable for promoting patient mobility. Regular repetitions and physiotherapy services at off-peak times are essential to ensure sustainability.
Zusammenfassung. Hintergrund: Healthcare-assoziierte Infektionen (HAI) bei stationären Patient_innen führen zu einem erschwerten Behandlungsverlauf. In Europa entwickeln 5,5 % der Patient_innen eine HAI. Etwa die Hälfte dieser Infektionen wäre vermeidbar. In der Klinik für Traumatologie des Universitätsspitals Zürich planten wir ein Maßnahmenpaket, um HAI zu reduzieren. Der Fokus lag auf nicht-ventilatorassoziierten nosokomialen Pneumonien (nvHAP). Ziel: Zusätzlich zur nvHAP-Reduktion war es unser Ziel, die Mobilität der Patient_innen zu erhöhen, die Pflegefachpersonen zu befähigen und die multiprofessionelle Zusammenarbeit zu stärken. Methode: Um diese Ziele zu erreichen, führten wir ein Praxisentwicklungsprojekt durch. Es umfasste Fortbildungen, Workshops, Informationsposter, strukturelle Änderungen und die begleitete Aktion „Mobilisationswochen“. Ergebnisse: Die Mobilisationen erhöhten sich um 40 %, die Mobilisationsdauer um 46,5 %. Die deutliche Steigerung der mobilisationsbezogenen Interventionen im Halbjahresvergleich liegt bei 7,6 %. Pflegefachpersonen berichteten über Wissenszuwachs, stark verbesserte multiprofessionelle Zusammenarbeit und erhöhte Betreuungsqualität. Diskussion: Durch die Verbindung verschiedener Methoden und mithilfe eines multiprofessionellen Ansatzes lässt sich ein nachhaltiger Effekt auf die Anzahl mobilitätsbezogener Interventionen erzielen. Grenzen und Transfer: Gezielte Praxisentwicklung eignet sich, um die Patientenmobilität zu fördern. Regelmäßige Wiederholungen und die Präsenz der Physiotherapie zu Randzeiten sind zentral, um Nachhaltigkeit sicherzustellen.

CME Sonography 98/Answers: Chest Ultrasound Abstract. Chest sonography has long been an important part of ultrasound diagnostics. Historically, the first evidence found in chest sonography were pleural effusions. Peripheral consolidations (pneumonia, tumors, pulmonary embolism) and pneumothorax were added later. The COVID-19 pandemic with often massive lung infestation has significantly increased the interest in thoracic sonography. The partially specific changes caused by COVID-19 are presented in this article.
Zusammenfassung. Die Thoraxsonografie zähl seit Langem zu einem wichtigen Bestandteil der Ultraschalldiagnostik. Historisch war zuerst der Nachweis von Pleuraergüssen da. Später kamen auch periphere Konsolidationen (Pneumonie, Tumore, Lungenembolie) und Pneumothorax dazu. Die COVID-19-Pandemie mit oft massivem Lungenbefall hat das Interesse an der Thoraxsonografie deutlich verstärkt. Die zum Teil spezifischen Veränderungen durch COVID-19 werden nachfolgend vorgestellt.

COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization? Abstract. Switzerland has been severely affected by the COVID-19 pandemic. The clinical spectrum of this disease in terms of its clinical presentation and course is very broad. A correct initial evaluation in the practice or in the emergency department is important and includes history-taking and clinical examination as well as imaging and laboratory tests. Most patients with COVID-19 can be treated as outpatients. Hospitalization may be necessary in patients with a marked COVID-19 pneumonia or further complications, which occur primarily in the second or third phase of the disease. The dynamics of the disease must also be taken into consideration. In outpatients, symptomatic therapy is often sufficient, antibiotics and corticosteroids are not indicated.
Zusammenfassung. Die Schweiz ist von der COVID-19-Pandemie stark betroffen. Das klinische Spektrum dieser Erkrankung hinsichtlich klinischer Präsentation und Verlauf ist breit. Eine korrekte initiale Beurteilung in der Praxis oder auf der Notfallstation ist wichtig und umfasst neben Anamnese und klinischer Untersuchung auch bildgebende Verfahren und Laboruntersuchungen. Die meisten Personen mit COVID-19 können ambulant behandelt werden. Eine Hospitalisation kann notwendig werden bei Kranken mit ausgeprägter COVID-19-Pneumonie oder weiteren Komplikationen, die vor allem in der 2. und 3. Phase der Erkrankung auftreten. Auch muss die Dynamik der Erkrankung in die Überlegungen mit einbezogen werden. Bei ambulanten Patientinnen und Patienten erfolgt in der Regel eine symptomatische Therapie, Antibiotika oder Kortikosteroide sind nicht indiziert.

CME Sonography 98: Chest Ultrasound Abstract. Chest sonography has long been an important part of ultrasound diagnostics. Historically, the first evidence found in chest sonography were pleural effusions. Peripheral consolidations (pneumonia, tumors, pulmonary embolism) and pneumothorax were added later. The COVID-19 pandemic with often massive lung infestation has significantly increased the interest in thoracic sonography. The partially specific changes caused by COVID-19 are presented in this article.
Zusammenfassung. Die Thoraxsonografie zähl seit Langem zu einem wichtigen Bestandteil der Ultraschalldiagnostik. Historisch war zuerst der Nachweis von Pleuraergüssen da. Später kamen auch periphere Konsolidationen (Pneumonie, Tumore, Lungenembolie) und Pneumothorax dazu. Die COVID-19-Pandemie mit oft massivem Lungenbefall hat das Interesse an der Thoraxsonografie deutlich verstärkt. Die zum Teil spezifischen Veränderungen durch COVID-19 werden nachfolgend vorgestellt.