High prevalence of pneumonia in children of a smelter town.

Since German reunification in 1990, most heavy industries in Eastern Germany have been shut down. Although air quality has improved in terms of sulfur dioxide and particulate matter (PM), the content of certain metals in PM in industrial areas is persistently high. Lifetime pneumonia prevalence in schoolchildren born after unification in the heavy-metal industrial area Hettstedt remain elevated. One difference between low and high pneumonia-prevalence areas seems to be the residual concentrations of heavy metals in respirable air. Toxicological and human exposure studies of Hettstedt particles have shown metal-rich PM from Hettstedt to have greater toxicity and inflammatory properties than the PM of the control region. Past industrial emissions might still play a decisive role decades after the closing of sources, and pneumonia should be considered a possible acute health burden caused by metal-rich air pollution.

Antibiotic treatment of community acquired pneumonia varies widely across Germany.

UNLABELLED: Community Acquired Pneumonia (CAP) is a frequent and potentially fatal infectious disease which, in the majority of cases, needs an antibiotic intervention. OBJECTIVES: Aim was to evaluate antibiotic treatment patterns regarding all types of mono- and combination-therapy throughout the local clinical centres (LCCs) represented in the German competence network CAPNETZ (=Community Acquired Pneumonia Network) and to identify clinical indicators for regional differences. METHODS: We analysed outpatients and inpatients recruited between March 2003 and April 2005. Patient and treatment details were registered online using standardised data entry forms. A logistic regression model was issued for the 4 most frequently applied antibiotics, adjusting for potentially relevant confounders. RESULTS: The study sample consisted of 3221 patients at the age of 18 to 102 years. Overall, aminopenicillins plus betalactamase inhibitor (20.4%), fluoroquinolone (17.0%), macrolides combined with cephalosporins third generation (10.6%) and cephalosporins third generation (8.9%) were most frequently prescribed. After control for potential confounders, significant treatment differences remained between study sites. Regional variability of antibiotic CAP-treatment could not be attributed to a number of clinical or sociodemographic factors. CONCLUSIONS: The presented treatment variability ranges within given guidelines, but indicates the need for an ongoing implementation of evidence-based guidelines in order to avoid potential negative clinical or economic consequences.