RESPIRE score: derivation and validation of a new risk score for prediction of community-acquired pneumonia caused by resistant pathogens

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ID: 314565
2026
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Abstract
Abstract Background Community-acquired pneumonia (CAP) remains a leading cause of infectious mortality worldwide. The increasing prevalence of multidrug-resistant (MDR) pathogens challenges the established empirical antibiotic therapy schemes. This study aimed to derive and validate a clinical score (RESPIRE) to identify CAP-MDR patients. Methods We conducted an observational study in a setting of medium-high MDR endemicity. The primary outcome was the derivation of a clinical score predicting MDR CAP. A retrospective derivation cohort (January 2022–December 2023) including adult patients hospitalized with microbiologically confirmed CAP by culture on respiratory samples was used for score derivation. A prospective cohort (January 2024-December 2025) including adult patients with the same clinical features was used for score validation. Results The derivation cohort included 275 patients (mean age 68.3 years), with an MDR prevalence of 30.1% (n=83). The RESPIRE score assigns 1.5 points for recent hospitalization and prior antibiotic use, and 1 point each for enteral feeding, poor functional status, and residence in long-term care facilities (maximum 6 points). A cutoff ≥2 showed optimal performance in predicting CAP-MDR (AUROC 0.85; 95% CI 0.80–0.91), outperforming other scores except DRIP. Validation in 141 patients (39% MDR) confirmed an AUROC of 0.88 (95% CI 0.74–0.89) showing better performance compared to other diagnostic models. Conclusions The RESPIRE score outperformed HCAP criteria and other clinical scores in predicting CAP-MDR. Its implementation in protocols could support antimicrobial stewardship for empiric treatment of cases of CAP presenting at the Emergency Department. A multicenter validation is warranted to confirm the performance of the RESPIRE score
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Authors Lorenzo Pelagatti, Martina De Marco, Emma Bosco, Tullio Catalucci, Michele Gilardoni, Francesca Mangani, Michele Spinicci, Alessandro Bartoloni, Gian Maria Rossolini, Peiman Nazerian, Simone Vanni
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag319
URL
https://doi.org/10.1093/ofid/ofag319
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