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Clinical expertise in infectious diseases is crucial in treating patients with infectious complications. The new board certification in infectious diseases will establish this expertise in Germany. The role of the specialty of infectious diseases in German hospitals and the definition for clinical services in hospitals (levels 2 and 3) are outlined here. Spezifische infektiologische Kompetenz verbessert die stationäre Versorgung von Patienten mit Infektionskrankrankheiten. Mit der neuen Facharztbezeichnung Innere Medizin und Infektiologie wird diese Expertise auch in Deutschland zugänglich. Die strukturelle Einbindung der Infektiologie und die Definition einer Leistungsgruppe in Kliniken der Level 2 und 3 werden dargestellt.

From an infectious disease perspective, there have been outstanding findings since January 2020 far beyond the knowledge gained about SARS-CoV, which hopefully will help us to manage future pandemics. Positive highlights include the increased public awareness of infectious disease epidemiology, the increase in immunological knowledge, and the successful use of existing vaccine development platforms and technologies. This article presents a personal selection of interesting developments in recent months.

The control and management of infection with the novel SARS-CoV-2 virus requires multidisciplinary work between specialists on all levels. This article aims to provide an overview of the current knowledge of COVID-19 from the view of infectious diseases physicians including all the uncertainties of our understanding of the pathogenesis and immunity.

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.Die Infektiologie ist ein Querschnittsfach mit Verbindungen zu vielen medizinischen Disziplinen und bietet interessierten Ärztinnen und Ärzten eine Vielzahl von interessanten Betätigungsfeldern. Das Spektrum umfasst sowohl die ambulante und stationäre Patientenversorgung als auch grundlagenorientierte, klinische und epidemiologische Forschung. Der Bedarf an infektiologisch weitergebildeten Ärztinnen und Ärzten steigt, sodass die Berufsaussichten als sehr gut einzuschätzen sind. Die Vereinbarkeit von Beruf und Familie in der Infektiologie ist vergleichsweise günstig. Mit diesem Artikel wollen wir bei jungen Kolleginnen und Kollegen Interesse an diesem vielseitigen und spannenden Querschnittsbereich wecken und Berufsperspektiven aufzeigen. Daten aus einer Mitgliederbefragung der Deutschen Gesellschaft für Infektiologie e. V. geben Einblicke, in welchen Bereichen und mit welchen Tätigkeitsschwerpunkten Infektiologen heute überwiegend tätig sind.

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.Die Infektiologie ist ein Querschnittsfach mit Verbindungen zu vielen medizinischen Disziplinen und bietet interessierten Ärztinnen und Ärzten eine Vielzahl von interessanten Betätigungsfeldern. Das Spektrum umfasst sowohl die ambulante und stationäre Patientenversorgung als auch grundlagenorientierte, klinische und epidemiologische Forschung. Der Bedarf an infektiologisch weitergebildeten Ärztinnen und Ärzten steigt, sodass die Berufsaussichten als sehr gut einzuschätzen sind. Die Vereinbarkeit von Beruf und Familie in der Infektiologie ist vergleichsweise günstig. Mit diesem Artikel wollen wir bei jungen Kolleginnen und Kollegen Interesse an diesem vielseitigen und spannenden Querschnittsbereich wecken und Berufsperspektiven aufzeigen. Daten aus einer Mitgliederbefragung der Deutschen Gesellschaft für Infektiologie e. V. geben Einblicke, in welchen Bereichen und mit welchen Tätigkeitsschwerpunkten Infektiologen heute überwiegend tätig sind.

Digital Medicine has become an integral part of clinical infectious diseases. For chronic infections such as HIV and Hepatitis C, treatment with software tools for resistance phenotyping has become standard of care. Computer-assisted decision aids as well as electronic health records are currently being implemented on a regional basis in Germany. They assist physicians in avoiding treatment errors and selecting antibiotics rationally.Mobile devices allow documentation of the course of chronic infections and improve communication between patient and physician. This offers new opportunities in areas with underdeveloped health infrastructure. In the future, it will become possible to integrate complex datasets, such as genome and microbiome, into clinical treatment decisions. This would adjust treatment individually based on host immune response, metabolism, and microbiota colonization.Über Impfungen und gezielte Erregerdiagnostik und -therapie ist die Infektionsmedizin Vorreiterin der personalisierten Medizin. Datenprozesse im Rahmen neuer Infektionsepidemien sind Musterbeispiele der Möglichkeiten der digitalen Medizin.Die oft gut definierten Krankheitsbilder der Infektiologie und das hohe Niveau der verfügbaren Leitlinien sind ideale Voraussetzungen für computerunterstützte Behandlungsentscheidungen.Durch die Verbindung von Daten aus elektronischen Patientenakten mit den umfassenden Datensätzen neuer Technologien aus der sogenannten „Omics“-Forschung können neue Zusammenhänge erkannt und Prognosen verbessert werden.Die elektronische Gesundheitsakte eröffnet großes Potenzial im Sinne einer zielgerichteten Behandlung, insbesondere bei infektiologischen Notfällen.In Deutschland fehlen Infektiologen, ein Strukturwandel kann nur schrittweise vollzogen werden. Telemedizinische Konsultationen können helfen, infektiologische Expertise in unzureichend versorgte Regionen zu bringen.Die fast vollständige Verbreitung mobiler Digitalgeräte schafft neue Möglichkeiten für die Gestaltung der Arzt-Patient-Kommunikation sowie der heimatnahen Nachsorge.Beim Langzeitmanagement chronischer Erkrankungen sowie bei der Versorgung in Regionen mit schwacher Infrastruktur entstehen Möglichkeiten einer verbesserten medizinischen Behandlung.Die Digitale Medizin birgt Risiken durch die Schaffung großer Datensätze mit potenziell stigmatisierenden Patienteninformationen. Softwaresysteme, die Entscheidungen von klinischer Relevanz beeinflussen, bedürfen sorgfältiger Prüfung und Transparenz.

Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.

Recently, epidemiological data shows an increase of childhood tuberculosis in Germany. In addition to this, drug resistant tuberculosis becomes more frequent. Therefore, diagnosis, prevention and therapy in childhood and adolescence remain a challenge. Adult guidelines do not work for children, as there are age specific differences in manifestation, risk of progression and diagnostic as well as therapeutic pathways.The German Society for Pediatric Infectious Diseases (DGPI) has initiated a consensus-based (S2k) process and completed a paediatric guideline in order to improve and standardize care for children and adolescents with tuberculosis exposure, infection or disease.Updated dosage recommendations take age dependant pharmacokinetics in the treatment of drug sensitive but also drug resistant tuberculosis in account. In addition to this, there is a detailed chapter on perinatal exposure and disease as well as extrapulmonary manifestations.Aktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenüber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Prävention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar.Leitlinien für die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter können nicht generell auf das Kindesalter übertragen werden, da hier relevante altersabhängige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Maßnahmen und der Therapie bestehen.Unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie für die Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adäquate Versorgung von Kindern und Jugendlichen mit Tuberkulose-Exposition, Infektion oder Erkrankung nach neuesten wissenschaftlichen Erkenntnissen zu sichern.Aktualisierte Dosierungsempfehlungen berücksichtigen die altersabhängige Pharmakokinetik in der Therapie der medikamentensensiblen, aber auch resistenten Tuberkulose. Darüber hinaus werden die Themen perinatale Exposition und Erkrankung sowie die im Kindesalter häufigeren extrapulmonalen Manifestationsformen gesondert behandelt.

Systematic recording of practical implementation of current recommendations of KRINKO for the prevention of nosocomial infections in premature and newborn infants in children's hospitals in Thuringia. All neonatal treatment centers in Thuringia (n=18) were included in this survey. Answer were received from 83% (15/18). Degree of compliance was 100% in level-1 (3/3) and level-2 centers (5/5), and 70% in level-3 centers (7/10). The aim of the questionnaire was to evaluate infection prevention measures as well as structural/organizational parameters in neonatal centers in Thuringia. Preventive measures as well as weekly screening for colonization was fully performed in patients with a birth weight1 500 g (n=205) at all centers. Additionally, prolonged screening and colonization surveillance measures were performed in 60% of all units until discharge from the hospital. Results related to structural/organizational parameters and especially structural conditions in neonatal centers in Thuringia pointed up challenges (2 m minimum distance between incubators in 27% (n=4/15), isolation in single room in 53% (n=8/15)). Insufficient number of staff also hamper the complete implementation of KRINKO recommendations (intensive care unit: patient/staff ratio (MW±SD) 2.5±1.1; newborn area 4.3±0.9). Analysis shows actual rate of implementation of KRINKO recommendations as well as structural/organizational parameters in neonatal treatment centers in Thuringia. It provides important points for discussion regarding necessary staff numbers and structural conditions. Analysis could also be used for future surveys in other regions in Germany.

Tuberculosis is a rare disease in Germany. This is the result of systematic treatment, contact tracing, and supervision of public health institutions, but even more of good nutrition and immunity of the population. Considering migration waves, a higher incidence of non-diagnosed tuberculosis may be expected. Due to the airborne type of infection and constant manipulation of the airway, those working in anesthesia, intensive care and emergency medicine are exposed to an increased risk of infection with tuberculosis. To avoid hospital and community infection, several guidelines of national and international organizations are available.This article gives a summary of the mechanism and probability of infection, diagnosis of infection andpathogen detection; important guidelines are referred to, and everyday situations with risk of infection and their avoidance are described. The message is that self-protection should be possible by information and awareness.

Clinical infectious diseases have only slowly been established as a medical specialty in Germany. The density of infectious diseases (ID) specialists and the number of ID divisions in general hospitals is still limited when compared with the situation in many other European countries, and there is also a lack of hospital-based medical microbiologists and infection control doctors for many reasons. Often, there is a lack of understanding of the roles and the performance of ID specialists versus microbiologists. Experience in other countries shows that ID specialists are important as clinical experts at the bedside, can help ascertain healthcare quality and patient safety, and are perfectly suited for undertaking strategic tasks in the field of cost-effective antimicrobial therapy algorithms and antibiotic stewardship (ABS) in hospitals. ID specialists are responsible for infection control in several countries, can improve the utility of diagnostic microbiology and are key partners in translational research. We estimate that more than 1,000 additional ID specialists are needed in this country, and believe that specially trained ABS experts can take over parts of their responsibilities and tasks in smaller hospitals. More capacity and flexibility in postgraduate training in infectious diseases, antibiotic stewardship and infection control in Germany will be critical to address the problem of antimicrobial resistance. (As supplied by publisher).

Infectious diarrhea is very common; its severity ranges from uncomplicated, self-limiting courses to potentially life-threatening disease. A rapid diagnostic workup providing detailed information on the suspected pathogen should be performed only in patients at risk, analyzing one single stool sample for Salmonella, Shigella, Campylobacter, and Norovirus. In the presence of risk factors, such as a history of antibiotic exposure within the last 3 months, testing for Clostridium difficile should be performed. Immunocompetent patients do not require specific antibiotic therapy. Exceptions exist in patients with severe comorbidities, immunodeficiency, fever/SIRS, and in patients with Shigella or C. difficile infection. Empirical antibiotic treatment should be considered in patients with fever and/or bloody diarrhea and in patients at risk. In patients with traveler's diarrhea, microbiological diagnosis is required only in patients with fever, bloody diarrhea, prolonged course of disease (more than 5 days), severe clinical course with hypotension or dehydration, and during outbreaks. In these patients one single fecal sample should be collected for stool cultures of Campylobacter, Shigella, and Salmonella, as well as microscopic examination for amoebiasis and Giardiasis. The main therapeutic measure for infectious diarrhea is sufficient oral rehydration. As in community-acquired diarrhea, azithromycin or ciprofloxacin are recommended-taking into account local antimicrobial resistance in the country of travel and possible side effects.

Because the development of resistance is steadily increasing, especially among Gram-negative pathogens and new developments in antibiotics are lacking, a rational antibiotic therapy is necessary now more than ever. A continuing uncritical and non-guideline-conform use of antibiotics leads to selection of multidrug-resistant pathogens, which can colonize patients and as instigators of infections make treatment more difficult. A prerequisite for targeted antibiotic therapy is a critical testing of the suspected infection diagnosis based on a guideline-conform microbiological preanalytical procedure. To promote a guideline-conform antibiotic therapy in hospitals with respect to choice of substance, dosage and duration, in December 2013 so-called antibiotic stewardship (ABS) measures were summarized in a so-called S3-guideline from the Association of the Scientific Medical Societies in Germany (AWMF) under the auspices of the German Society for Infectious Diseases (DGI). With a strategy of targeted antibiotic therapy and infection prevention it is possible to achieve optimum treatment results and to minimize the development of resistance.

One of the core strategies to optimize antiinfective therapy is to review antibiotic prescriptions. Therefore, Antibiotic Stewardship (ABS) team members either attend ward rounds or perform a chart review to provide feedback to and discuss with the attending physician. Acceptance and effectiveness of both options are discussed in this article.Attending physicians were asked to complete a questionnaire evaluating ABS activities. The modality of the reviewing process and its effectiveness, as well as the feasibility of recommendations was assessed. As the degree of implementation of ABS recommendations decreased on a trauma ward, the reviewing process was changed from chart review to attending the daily ward rounds. In this setting, the duration of the reviewing process and the consumption of antiinfectives in recommended daily doses/100 patient days (RDD/100PT) were assessed, comparing the two intervention modalities.Attending physicians predominantly appreciated the modality and extent of ABS currently offered to them by the ABS team, rating it relevant and effective. Implementation of ABS recommendations was increased on the trauma ward by academic detailing during the daily ward round; the consumption of broad spectrum antibiotics was reduced.ABS team members with formal authority and dedicated time for antibiotic stewardship activities effectively optimize antiinfective therapies by reviewing antibiotic prescriptions. The interaction of ABS experts and attending physicians contributes fundamentally to the effectiveness and degree of implementation of ABS interventions.

While trained infectious diseases (ID) specialists are regularly involved in inpatient and outpatient care in the United States and Canada, these specialized services are only rarely established in Germany. This article aims to summarize the findings of numerous studies that investigated the impact of ID consultation services on patient care and outcome in patients suffering from infectious diseases. The strongest evidence for a clinical benefit is found in the context of Staphylococcus aureus bacteremia (SAB), where in-hospital- and day-30 mortality was significantly and consistently reduced by about 40% in patients that were evaluated and treated in cooperation with an ID physician. Furthermore, studies revealed that this effect was associated with an improved adherence to standards of care. Newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal or curbside consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for the improved quality of care and treatment outcomes in patients with infectious diseases. Thus, strong consideration should be given to establish ID consultation services in small and medium sized hospitals as well.

The "ABS-training initiative" was funded by the German Ministry of Health as part of the German Antimicrobial Resistance Strategy (Deutsche Antibiotika-Resistenz-Strategie, DART) from 2009 until early 2014. The initiative was designed for clinicians and clinical pharmacists and contains several training units covering antiinfectives, infectious diseases and ABS strategies including the conduction of a research project at the participants' hospital. Participants who complete the four-weeks training initiative will become a certified "ABS Expert". 281 ABS Experts were asked to take part in a survey (staff for ABS, surveillance data about agents and consumption, ABS activity) to estimate the influence of the ABS-training initiative on the ABS-structural quality. The evaluation was performed using GrafStat (V 4.255), statistical software package for the evaluation of surveys. Ninety-two ABS Experts representing 92 hospitals participated in a questionnaire-based survey before and after completing the training initiative. Forty (44 %) hospitals appointed an ABS representative (+22 %) after completing the training initiative. Antibiotic surveillance data available as a report increased from 34 (40 %) to 54 (60 %) and correct data presentation (DDD or RDD/100 days) from 7 (8 %) to 40 (43 %). Proactive auditing of antiinfective prescribing improved from 54 (60 %) to 71 (78 %) in intensive care units, and from 28 (31 %) to 53 (58 %) on normal wards. Availability of local guidelines increased from 36 (39 %) to 52 (57 %). The "ABS Training Initiative" had a positive impact on ABS-structural quality regarding nomination of ABS-teams, surveillance data of antibiotic consumption, implementation of proactive auditing of antiinfective prescribing and availability of local guidelines. However, there is optimization potential in many sectors. The short time period between pre- and post-assessment and the ongoing personnel or time constraints need to be taken into account.

Proactive audit of antibiotic use ensures quality of prescribing and can improve outcome in patients with infections. A rational, individualized therapy is being defined in interdisciplinary cooperation on the basis of clinical, laboratory, radiological and microbiological examination findings. By fostering targeted antibiotic therapy proactive audit reduces adverse effects and contributes to drug therapy safety and subsequently to patient safety. A proactive audit of antibiotic use is performed weekly on four intensive care units at the University Hospital Dresden by a infectious disease specialist a pharmacist and the attending physicians. Patient-related therapy adjustments were systematically documented over a 4-month period; antibiotic use before and after audit as well as ABS strategies (de-escalation, oral switch, duration of treatment, dose and administration optimization) were analyzed. Both targeted therapy and interventions regarding the duration of treatment led to a reduction in the prescribing of broad spectrum antibiotics by 20%. Routine interdisciplinary proactive audit of antibiotic use with intervention and feedback increases guideline-adherent therapy and process quality.

Das Cytomegalievirus (CMV) ist die haufigste virale Infektion, die nach der Transplantation solider Organe zu schwerwiegenden Komplikationen fuhren kann. Eine deutsche Expertengruppe hat nun die im Jahr 2013 veroffentlichten internationalen Konsensus-Leitlinien zu CMV bei Transplantation solider Organe zusammengefasst und bewertet.

Treatment of hepatitis C is changing dramatically. Various new direct-acting antivirals (DAA) against HCV have recently been approved or will become available during the next months.To summarize the efficacy of DAAs and to describe optimal treatment regimens for chronic hepatitis C.Review of selected phase 2 and 3 trials investigating anti-HCV drugs and recent HCV guidelines.New HCV therapies are interferon-free and lead to sustained HCV clearance in90% of cases. DAAs include HCV protease inhibitors, NS5A inhibitors as well as nucleotide and non-nucleoside HCV polymerase inhibitors. Depending on the stage of liver disease, HCV genotype and viral load, treatment duration is 8-24 weeks. Ribavirin is not needed anymore in every case. Resistance against HCV drugs is not a major factor determining treatment response, but resistance testing is recommended in case of treatment failures before re-treatment is considered.Chronic hepatitis C is a curable disease. It remains to be determined to what extent HCV clearance will alter liver function and the risk for hepatocellular carcinoma in patients with liver cirrhosis.

Resistance against antibiotics is continuously increasing throughout the world and has become a very serious problem. For just this reason "Antibiotic Stewardship Programs" have been developed. These programs are intended to lead to a sustained improvement in the situation and to assure a rational practice for the prescription of anti-infective agents in medical facilities. The aim is to prescribe the correct antibiotic therapy to the right patient at the most appropriate point in time. An AWMF S3 guideline on this topic published by the German Society for Infectiology (S3-Leitlinie StrategienzurSicherungrationalerAntibiotika-AnwendungimKrankenhaus.AWMF-Registernummer 092/001 - S3 Guideline on Strategies for the Rational Use of Antibiotics in Hospitals. AWMF - Registry Number 092/001) has been available since the end of 2013. An essential aspect therein is the expert interdisciplinary cooperation of a team comprising a clinically experienced infectiologist, a hospital pharmacist and a consultant for microbiology.

The German STI guidelines for gonococcal and chlamydial infections were recently updated. Representing the German Society of Urology (DGU) in these guidelines consensus processes, the authors summarize the recommendations regarding screening, appropriate laboratory diagnostics and dose-increased dual antimicrobial therapy of urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Urologists need to be informed about an approaching era of untreatable gonorrhea. Although of limited use, whenever possible Neisseria gonorrhoeae cultures are required to monitor developing resistance to current treatment regimes. Recommendations for the use of nucleic acid amplification tests (NAATs) for detection of chlamydia and gonorrhea as the standard laboratory test remain. Because the majority of persons infected by Chlamydia trachomatis are not aware of the infection, untreated infection can lead to serious complications later on with the burden of disease and infertility sequelae considered to be a predominantly female problem. Principally, both partners should be treated simultaneously in order to prevent re-infection. Furthermore, therapy control is recommended for every gonorrhea.

Intra-abdominal infections (IAI) are a common problem in visceral medicine. In Germany more than 150 000 patients are treated each year for IAI with courses ranging from uncomplicated disease to severe life-threatening manifestations. IAI represent the second most common cause of septic shock and the second most common cause of infection-related mortality in intensive care. Due to increasing antimicrobial resistance, changes in pathogen spectra and increasing patient co-morbidities, recommendations for empirical antibiotic therapy have to be continuously updated: Whereas inadequate empirical treatment is associated with poor prognosis, unselected broad-spectrum therapy may increase antimicrobial resistances. Illustrated by clinical cases of typical intra-abdominal infections, this article reviews recommendations for antibiotic therapy based on national and international guidelines under consideration of local resistance rates and patient-specific factors to provide a basis for improved therapy of this common problem.

The sepsis syndrome has only recently been defined as a clinical syndrome but despite its unspecific definition it has evolved rapidly into an important concept. Although specific therapeutic interventions targeting the inflammatory pathway have not yet been effective in treating sepsis, a better understanding of mechanisms leading to organ dysfunction has led to better management of patients with sepsis. Clinical signs of systemic inflammatory response syndrome (SIRS) or sepsis are hallmarks for the definition of severe infections. Current guidelines are presented for the management of a number of severe infectious syndromes.