{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:05:31Z","timestamp":1783969531614,"version":"3.55.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100011852","name":"Paracelsus Medical University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011852","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Pneumonia remains a leading cause of morbidity and mortality worldwide. The COVID-19 pandemic has significantly altered the epidemiological landscape of respiratory infections. Understanding current etiological patterns and risk factors is crucial for optimal patient management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize the etiological spectrum of pneumonia and identify clinical and laboratory factors associated with both in-hospital and post-discharge mortality in a large cohort of patients treated during the COVID-19 era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 1,848 adult patients hospitalized with pneumonia at a tertiary care hospital in Linz, Austria, between January 2020 and January 2024. Data included demographics, comorbidities, laboratory findings, microbiological results, and mortality outcomes. Statistical analyses included univariate correlations and Cox regression models for survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>\n                      Etiological agents were identified in only 26.4% of cases, with SARS-CoV-2 being the most frequently detected pathogen (8.7%). In-hospital mortality was 15.1%. Significant risk factors for in-hospital mortality included chronic kidney disease (\n                      <jats:italic>\u03c6<\/jats:italic>\n                      \u2009=\u20090.057,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015), dysphagia (\n                      <jats:italic>\u03c6<\/jats:italic>\n                      \u2009=\u20090.061,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), malignancy (\n                      <jats:italic>\u03c6<\/jats:italic>\n                      \u2009=\u20090.086,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and detection of specific pathogens including Candida albicans, Staphylococcus aureus, and Enterobacter cloacae. Higher HDL levels (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009-0.120,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and longer hospital stays were associated with improved survival. Post-discharge mortality risk factors included advanced age, elevated CRP levels, and multiple comorbidities, while obesity demonstrated a paradoxical protective effect (HR\u2009=\u20090.628,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study reveals a high rate of unidentified pathogens and identifies specific clinical and microbiological factors associated with pneumonia outcomes during the COVID-19 era. The obesity paradox and protective effect of HDL cholesterol warrant further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10633-x","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:27:25Z","timestamp":1783967245000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumonia Etiology and Risk Factors in a Tertiary Hospital During the COVID-19 Era: A Retrospective Analysis (2020\u20132024)"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3443-9943","authenticated-orcid":false,"given":"Nikolaus","family":"Clodi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Berthold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Clodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Resl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"11","key":"10633_CR1","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1164\/rccm.202408-1540ED","volume":"210","author":"C Cilloniz","year":"2024","unstructured":"Cilloniz C, Dela Cruz CS, Dy-Agra G, Pagcatipunan RS Jr. World Pneumonia Day 2024: Fighting Pneumonia and Antimicrobial Resistance, (in eng). Am J Respir Crit Care Med. 2024;210(11):1283-1285. https:\/\/doi.org\/10.1164\/rccm.202408-1540ED.","journal-title":"Am J Respir Crit Care Med."},{"key":"10633_CR2","doi-asserted-by":"publisher","unstructured":"Lee T, Walley KR, Boyd JH, Cawcutt KA, Kalil A, Russell JA. Impact of the COVID-19 pandemic on non-COVID-19 community-acquired pneumonia: a retrospective cohort study, (in eng). BMJ Open Respir Res. 2023;10(1). https:\/\/doi.org\/10.1136\/bmjresp-2023-001810.","DOI":"10.1136\/bmjresp-2023-001810"},{"key":"10633_CR3","doi-asserted-by":"publisher","unstructured":"Barber\u00e1n J et al. Epidemiology of the COVID-19 pneumonia in a group of hospitals from Madrid-Spain during the full period of the State of Alarm HM cohort, (in eng). Rev Esp Quimioter. 2025;38(2):97\u2013107. https:\/\/doi.org\/10.37201\/req\/110.2024. Epidemiolog\u00eda de la neumon\u00eda por COVID-19 en un grupo de hospitales espa\u00f1oles durante todo el Estado de Alarma - Cohorte de hospitales HM.","DOI":"10.37201\/req\/110.2024"},{"key":"10633_CR4","doi-asserted-by":"crossref","unstructured":"Vulpie S et al. Rapid Syndromic Testing: A Key Strategy for Antibiotic Stewardship in ICU Patients with Pneumonia. Antibiotics. 2025;14(5):426. [Online]. Available: https:\/\/www.mdpi.com\/2079-6382\/14\/5\/426.","DOI":"10.3390\/antibiotics14050426"},{"issue":"1","key":"10633_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jinf.2019.11.021","volume":"80","author":"S Poole","year":"2020","unstructured":"Poole S, Clark TW. Rapid syndromic molecular testing in pneumonia: The current landscape and future potential, (in eng). J Infect. 2020;80(1):1-7. https:\/\/doi.org\/10.1016\/j.jinf.2019.11.021.","journal-title":"J Infect."},{"key":"10633_CR6","doi-asserted-by":"publisher","unstructured":"Sun JK, Tian H. 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