[Practice-guided Presentation of the German S3 Guideline "Strategies to Warrant Rational In-hospital Use of Antibiotics"]. / Praxisorientierte Darstellung der deutschen S3-Leitlinie "Strategien zur Sicherung rationaler Antibiotika-Anwendungen im Krankenhaus".

The current S3 guideline entitled "Strategies to warrant rational in-hospital use of antibiotics" summarizes evidence-based antibiotic stewardship (ABS) measures that aim to improve clinical outcomes and prevent development and spread of microbial resistance in German hospitals. Most important prerequisite for efficiency and safety of ABS programs is sufficient staffing capacity as well as reliably operating surveillance of (i) pathogens, (ii) antimicrobial resistance and (iii) consumption of antimicrobials. ABS teams require authorization by hospital institutions as units exclusively responsible for antimicrobial audits and implementation of anti-infective interventions. Clinicians should be regularly granted access to in-hospital training programs delivered by ABS experts. Finally yet importantly, the current S3 guideline also highlights future goals, e.g., the structured involvement for nurses in ABS-guided infection management or the promotion of ABS programs in the outpatient sector and in veterinary medicine.

[When should a liver disease patient be admitted to the intensive care unit?] / Wann soll ein Leberkranker auf die Intensivstation?

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.