[Antibiotic Prescription Rates For Respiratory Tract Infections Treated In The Outpatient Sector Based On Routine Data From A German Health Insurance Company]. / Antibiotikaverordnungsraten bei ambulant behandelten Infektionen der oberen Atemwege anhand von Routinedaten einer deutschen Krankenkasse.

BACKGROUND: Acute uncomplicated upper respiratory tract infections (RTIs) are common reasons for antibiotic prescriptions in the outpatient sector, although>90% are of viral origins and mostly self-limiting. Germany has a low antibiotic prescription rate compared to other European countries, but there are regional differences. Disease-specific quality indicators (QI) developed by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) address the prescription rates (target <20%) and choice of antibiotic (target>80%) in a general practitioner population. The aim of this analysis was to operationalise the ESAC-Net-QI using secondary data from a health insurance company at the level of diseases and healthcare facilities, as well as to analyse areas for improvement. METHOD: The underlying database comprises the panel physician billing, hospital and prescription data in accordance with German law (§§ 295, 300 and 301 SGB V) of the Barmer health insurance company for the year 2022. Categorical features are presented as frequency and percentage. Maximum specificity was aimed, hence potentially risky disease courses were excluded. RESULTS: The overall RTI prescription rate of antibiotics was 25% in 2022 before applying inclusion and exclusion criteria (1,197,568/4,720,786). After applying the algorithm, the prescription rate for all RTI cases dropped to 6% (80,786/1,365,646). When specific RTI indications are considered, 35% (13,465/38,913) of acute bronchitis and acute sinusitis cases (4,971/14,051) received an antibiotic prescription each. At the facility level, 38% of practices (1,396/3,705) treating acute bronchitis and 41% of practices (539/1,300) treating acute sinusitis achieved the target of<20% antibiotic prescriptions. Only 29% of all RTI cases with antibiotic prescriptions (23,733/80,786) received a first-choice antibiotic. CONCLUSION: Our analysis indicates that the ESAC-Net-QI for RTIs can be calculated at case and facility levels using routine health insurance data. For specific RTIs, there were indications of improvement potential in the frequency and selection of prescribed antibiotics.

Peri- and postoperative cognitive and consecutive functional problems of elderly patients.

PURPOSE OF REVIEW: From an elderly patient's perspective, acute and chronic cognitive disturbances are among the most harmful complications that can occur following surgery. For elderly patients, these complications often mean the end of an independent life. This article focuses on this serious aspect, which is increasingly prevalent in our aging society. Cognitive disturbances are associated with severe outcome impairments and increased mortality. This article aims to provide a current overview regarding the diagnosis, pathophysiology, prevention, and treatment of this severe social problem. RECENT FINDINGS: The current knowledge of risk factors, diagnosis, prevention, and treatment of postoperative delirium and postoperative cognitive dysfunction should help to raise awareness and improve the outcome of delirious patients, particularly in the elderly population. SUMMARY: Especially in elderly patients, postoperative delirium constitutes a common, severe complication. Early diagnosis and supportive treatment are essential to improve outcome. To date, no pharmacological treatment strategy was effective, so that further research about the underlying pathophysiology and the development of treatment strategies are urgently required.