Background and aims: Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. Methods: This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30–60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. Results: In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09–1.26), previous institutionalization (29.1; 3.7–224.7), BI (1.09; 1.05–1.14), CCI (1.5; 1.1–2.1), and length of stay (1.1, 1.02–1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93–0.99) and length of stay (1.06; 1.00–1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20–51.21), BI (0.95; 0.92–0.98), and length of stay (1.12; 1.04–1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. Conclusions: After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.

Spontaneous bacterial meningitis (BM) is more common among patients with underlying conditions, but its characteristics in previously healthy patients are not well described. We analyzed the time trends of BM in terms of characteristics, and outcomes in patients without comorbidities. Patients and methods: Single-center, prospective observational cohort study of 328 adults with BM hospitalized in a tertiary university hospital in Barcelona (Spain). We compared the features of infections diagnosed in 1982–2000 and 2001–2019. The main outcome measure was in-hospital mortality. Results: The median age of the patients increased from 37 to 45 years. Meningococcal meningitis significantly diminished (56% versus 31%, p < 0.000) whereas listerial meningitis increased (1.2% versus 8%, p = 0.004). Systemic complications were more common in the second period, although mortality did not vary significantly between periods (10.4% versus 9.2%). However, after adjusting for relevant variables, infection in the second period was associated with lower risk death. Conclusions: Adult patients without underlying comorbidities that developed BM in recent years were older and more likely to have pneumococcal or listerial infections and systemic complications. In-hospital death was less likely in the second period, after adjusting for risk factors of mortality.

Background: Asymptomatic bacteriuria (ASB) is frequently overtreated in emergency departments (EDs), contributing to antimicrobial resistance without improving clinical outcomes. The rapid pace of clinical decision-making and high patient turnover in the ED further predispose clinicians to unnecessary antibiotic prescribing. Methods: A quasi-experimental study was conducted in the ED of a tertiary hospital in Barcelona, Spain, from January 2024 to September 2025. The intervention included targeted education for ED staff and daily audit-feedback on antibiotic prescriptions for suspected ASB. The outcomes were the following variables, compared between study periods: cases of ASB with unnecessary antibiotic treatment per month, antimicrobial consumption, urine culture (UC) requests, 30-day return visits to the ED for urinary tract infection, and 30-day all-cause mortality for safety assessment. Results: A total of 93 patients with suspected ASB in the pre-intervention period and 102 patients in the intervention period were included. The median cases of ASB with unnecessary antibiotic treatment per month decrease from 19 (IQR 16–26) in the pre-intervention period to 9 (IQR 9–13) in the intervention period (p = 0.018). Antimicrobial consumption declined: meropenem and imipenem decreased from 5.5 to 3.0 DDD/1000 admissions, ertapenem from 5.6 to 3.1, and ceftriaxone from 35.0 to 24.1. UC requests fell by 16.1%. Clinical safety outcomes did not differ significantly between periods: 30-day return visit to the ED for UTI with the same isolate dropped from 8.6% to 1.9% (p = 0.076), overall UTI return visits to the ED dropped from 11.8% to 5.9% (p = 0.225), and 30-day mortality remained stable (8.6% vs. 4.9%, p = 0.455). Conclusions: These findings support the use of combined educational and audit–feedback strategies as effective and safe Antimicrobial Stewardship interventions in high-intensity clinical environments such as the ED, as they reduce inappropriate antibiotic use and unnecessary UC requests without compromising patient safety.

Background: Asymptomatic bacteriuria (ASB) is frequently overtreated in emergency departments (ED), contributing to antimicrobial resistance without improving clinical outcomes. Rapid decision-making and high patient turnover in the ED increase the risk of unnecessary antibiotic use. Methods: A quasi-experimental study was conducted in the ED of a tertiary hospital in Barcelona, Spain, from January 2024 to June 2025. The intervention included targeted education for ED staff and daily audit-feedback on antibiotic prescriptions for suspected ASB. Outcomes were compared with a six-month pre-intervention period. The primary outcome was 30-day return visit to the ED for Urinary Tract Infection (UTI) with the same microbiological isolate. Secondary outcomes included 30-day all-cause mortality, overall UTI return visit to the ED, antimicrobial consumption (Daily Defined Dose/1,000 admissions), and urine culture requests. Results: A total of 130 patients in the pre-intervention period and 127 patients in the intervention period were included. In the intervention period, antibiotic discontinuation was recommended in 96 (75.6%) patients; acceptance rate was 29.2%. Despite limited acceptance, antimicrobial consumption declined, with cefalosporins reduced by 21% and carbapenems by 24%. Urine culture requests fell by 16.1%, and uropathogen isolates decreased by 15.9%. Clinical outcomes were similar between both periods: 30-day return visit to the EDs for UTI with the same isolate dropped from 6.2% to 1.6% (p-value=0,103), overall UTI return visit to the EDs from 8.5% to 4.7% (p-value=0.316), and 30-day mortality remained stable (6.2% vs. 3.9%, p-value=0.571), no statistically significant differences across all variables. Conclusions: This program reduced inappropriate antibiotic use and unnecessary urine testing in the ED without compromising patient safety. These results highlight educational and audit-feedback intervention as a safe, practical, and impactful antimicrobial stewardship strategy in high-pressure clinical settings as the ED.

Background: Antimicrobial prescribing in the emergency department is influenced by short stays, diagnostic uncertainty, and frequent empirical treatment initiation, which complicates the interpretation of antimicrobial use indicators. Days of antibiotic spectrum coverage (DASC) integrates duration and spectrum breadth and may provide complementary information for antimicrobial-use surveillance and stewardship. Methods: Retrospective observational study using aggregated quarterly data from adult ED episodes (January 2021-December 2025). Global antimicrobial use was assessed using Defined Daily Dose (DDD)/100 visits, DDD/100 patient-days, Days of Therapy (DOT)/100 visits, proportion of patients receiving antimicrobials, DASC/100 visits, and DASC/DOT. Trends were analyzed using temporal trend analysis. The main therapeutic groups were evaluated according to their contributions to the total DOT and DASC. Results: During the study period, global antimicrobial consumption decreased for most indicators. DDD/100 visits decreased from 11.28 in 2021 to 8.85 in 2025, DOT/100 visits from 19.08 to 13.31, and the proportion of patients receiving antimicrobials from 12.3% to 9.4%. DASC/100 visits decreased from 132.10 to 94.49 (28.5%). In contrast, DASC/DOT remained stable, with a slight increase from 6.92 to 7.10. Penicillins combined with beta-lactamase inhibitors were the largest contributors to DASC, followed by third-generation cephalosporins, fluoroquinolones, and carbapenems. The reduction in total DASC was mainly driven by decreases in third-generation cephalosporins, fluoroquinolones, metronidazole, and carbapenem exposure, whereas macrolide exposure increased over time. Conclusions: Metrics based on the DASC offer complementary insights to DDD and DOT and may assist antimicrobial stewardship programs in identifying ongoing broad-spectrum prescriptions in emergency care.