Helios Klinikum Emil von Behring

The updated S3 guideline on the "Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia", published in January 2024, provides evidence- and consensus-based recommendations aimed at improving care for this prevalent hospital-acquired infection. Replacing the 2017 version, the guideline was developed through an interdisciplinary process involving 14 professional societies. It includes 26 recommendations, covering extended diagnostic strategies (including multiplex PCR, biomarkers, and BAL) and tailored antimicrobial therapy. Key innovations include shortened treatment durations, targeted use of combination regimens, integration of viral and fungal pathogens, and a flowchart to guide empirical therapy. Emphasis is placed on antibiotic stewardship, reevaluation strategies, and resistance management. The guideline remains valid until February 2029.

(1) Background: To report two cases of severe tick-borne encephalitis (TBE) in elderly patients presenting with a previously undescribed subarachnoid T2/FLAIR hyperintensity on repeated MRI examinations, which may serve as an early imaging biomarker of disease severity. (2) Methods: Two unvaccinated 82-year-old patients (one male and one female) presented with acute encephalitis and required intensive care. Serial brain MRI, EEG, CSF analysis, and neurophysiological assessments were performed. (3) Results: Both patients showed rapid progressive neurological deterioration in the context of TBE, confirmed by elevated serum and CSF IgM and IgG titers. Early follow-up MRI revealed striking sulcal hyperintensities on T2/FLAIR sequences, interpreted as protein-rich subarachnoid inflammatory changes. These changes paralleled clinical worsening and resolved on follow-up imaging. The male patient developed meningoencephalomyeloradiculitis, remained comatose, and died from respiratory failure (the brain and spinal cord were examined postmortem). The female patient had meningoencephaloradiculitis with severe dysphagia and was discharged with a modified Rankin Scale score of four. Both patients demonstrated epileptiform EEG activity. The CSF analysis revealed markedly elevated total protein, lactate, tau protein, and CXCL13, as evidence of blood-brain barrier disruption and inflammatory neurodegeneration. (4) Conclusions: We describe acute subarachnoid T2/FLAIR hyperintensity in TBE as an imaging feature that may correlate with severe systemic inflammation and a poor prognosis. This radiological finding could serve as a potential early prognostic marker in TBE.

<bold>Introduction:</bold> Endoscopic lung volume reduction (ELVR) with one-way valves has been established as an effective and safe treatment for severe lung emphysema. But clinical studies often exclude or underrepresent older patients from their analysis. <bold>Methods:</bold> Data for this study originates from the Lungenemphysemregister e.V., which is a prospective, multicenter and national clinical study with a focus on the treatment of severe lung emphysema. Data on lung function, exercise capacity (6-MWD), quality of life and adverse events were collected at Baseline und at follow up from three to six months after intervention. Two groups were compared: age<70 and age≥70. <bold>Results:</bold> In total 360 patients were included. At baseline the younger cohort presented with less cardiovascular disease and a better lung function (FEV1 32.27 vs 27.2%, p<0.001; RV 242.8 vs. 262.8%, p=0.001). Table 1 shows no significant differences between both groups in the delta between baseline and follow-up. Older patients presented with a higher rate of pneumothorax after intervention (14.2 vs. 7.5%, p=0.04). Mortality did not differ significantly. <fig><object-id>erj;66/suppl_69/PA940/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> Conclusions: In conclusion, ELVR is effective in a real clinical setting, regardless of age. A higher rate of pneumothorax did not lead to higher mortality or worse outcomes for the older group.

Mycobacterium haemophilum is a fastidious nontuberculous mycobacterium that causes severe infections in immunocompromised patients. Due to its complex growth requirements, its detection and antimicrobial susceptibility testing (AST) remain challenging. This study aimed to compare the performance of a modified commercial broth microdilution method (Sensititre™ Myco susceptibility plates with added haemin) with the standard Clinical and Laboratory Standards Institute (CLSI) agar disk elution method for AST of M. haemophilum. We conducted 20 comparative AST tests on M. haemophilum ATCC 29548 and 10 clinical isolates, using the CLSI agar disk elution method as the reference. MICs were determined using both methods, and categorical concordance was assessed for multiple antibiotics. The overall concordance between methods was 81.4%. High agreement was observed for clarithromycin, linezolid, trimethoprim-sulfamethoxazole and rifampicin (90%-100%), while lower concordance was noted for amikacin (40%), ciprofloxacin (75%) and doxycycline (65%). Sensititre™ microdilution plates demonstrated superior standardization, ease of use and reduced contamination risks compared to the agar disk method. The modified Sensititre™ microdilution method is a reliable alternative to the agar disk elution method for AST of M. haemophilum. It provides precise MIC values and is better suited for routine clinical use due to improved reproducibility and efficiency.