{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T13:22:25Z","timestamp":1765286545673,"version":"3.46.0"},"reference-count":41,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cSpanish Foundation for Healthcare Quality\u201d"},{"name":"\u201cResearch Grant Program of the Hospitaller Order of Saint John of God (Territorial Unit II)\u201d (\u201cAyudas a la investigaci\u00f3n de la Orden Hospitalaria San Juan de Dios"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Community-acquired pneumonia (CAP) remains one of the leading causes of infectious mortality worldwide. Variability in diagnosis and management can significantly influence outcomes. Objective: To assess the association between the implementation of a standardized hospital protocol and clinical outcomes in patients hospitalized for bacterial CAP and to identify factors associated with in-hospital and 30-day mortality. Methods: An ambispective before\u2013after study was conducted at Hospital San Juan de Dios del Aljarafe (Seville, Spain), including a retrospective phase (2019) and a prospective intervention period (2022\u20132023). The intervention consisted of a standardized clinical protocol supported by training sessions and a 9-item checklist. Adults (\u226518 years) with clinically and radiologically confirmed bacterial CAP were included. Mortality, length of stay, and empirical and targeted antibiotic adequacy were compared between periods. In the prospective cohort (n = 169), mortality-associated factors were analyzed using multivariate logistic regression. Results: A total of 1610 patients were analyzed: 634 in the pre-intervention period and 976 during the intervention period. Hospital mortality was lower during the intervention (11.3% [95% CI 9.3\u201313.2] vs. 16.6%; [95% CI 13.7\u201319.5] p = 0.002) with an absolute risk difference of 5.3%, corresponding to an approximate number needed to treat (NNT) of 19. Median length of stay decreased slightly (8.1 vs. 7.9 days; p &lt; 0.001). In the prospective cohort, in-hospital mortality was 7.7% and 30-day mortality 16.6%. The therapeutic effort limitation (aOR 9.10, 95% CI 1.36\u2013121.57; p = 0.021) and lower SaO2\/FiO2 (aOR per unit 0.98, 95% CI 0.97\u20130.99; p &lt; 0.001) were independently associated with in-hospital mortality. The ARDS (aOR 4.29, 95% CI 1.05\u201319.93; p = 0.043), lower SaO2\/FiO2 (aOR 0.99 per unit, 95% CI 0.98\u20131.00; p = 0.005), older age (aOR 1.06 per year, 95% CI 1.02\u20131.12; p = 0.005), and lower Barthel Index (aOR 0.97 per point, 95% CI 0.94\u20130.99; p &lt; 0.001) were associated with higher 30-day mortality. Conclusions: Implementation of a standardized CAP protocol was associated with lower mortality and high antibiotic adequacy in the intervention cohort. While causal inference is limited by the non-contemporaneous before\u2013after design, these findings support the integration of structured, multidisciplinary, protocol-driven strategies\u2014together with periodic audit and feedback cycles\u2014to strengthen CAP management in community hospital settings.<\/jats:p>","DOI":"10.3390\/jcm14248704","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:42:43Z","timestamp":1765284163000},"page":"8704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Standardized Prospective Intervention in Hospitalized Patients with Bacterial Pneumonia"],"prefix":"10.3390","volume":"14","author":[{"given":"Mar\u00eda Roc\u00edo","family":"Fern\u00e1ndez-Ojeda","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital San Juan de Dios del Aljarafe (HSJDA), 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9278-9152","authenticated-orcid":false,"given":"Mar\u00eda Dolores","family":"Gal\u00e1n-Azcona","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital San Juan de Dios del Aljarafe (HSJDA), 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa Anastasia","family":"Garrido-Alfaro","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital San Juan de Dios del Aljarafe (HSJDA), 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0601-8952","authenticated-orcid":false,"given":"Mar\u00eda Victoria","family":"Ruiz-Romero","sequence":"additional","affiliation":[{"name":"Quality and Research Department, Hospital San Juan de Dios del Aljarafe, 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Fern\u00e1ndez-Moyano","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital San Juan de Dios del Aljarafe (HSJDA), 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1443-9236","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Garc\u00eda-Garmendia","sequence":"additional","affiliation":[{"name":"Intensive Care and Emergency Department, Hospital San Juan de Dios del Aljarafe, 41930 Bormujos, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0140-6736(21)00630-9","article-title":"Community-acquired pneumonia","volume":"398","author":"Aliberti","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1001\/jama.2024.14796","article-title":"Community-Acquired Pneumonia: A Review","volume":"332","author":"Vaughn","year":"2024","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1056\/NEJMcp2303286","article-title":"Community-Acquired Pneumonia","volume":"389","author":"File","year":"2023","journal-title":"N. 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