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Aim: To determine the prevalence and characteristics of pulmonary embolism (PE) in patients presenting with haemoptysis. Additionally, we assessed the efficiency and failure rates of different clinical diagnostic algorithms for PE in this patient population.Methods: We enrolled consecutive adult patients who presented to nine Italian emergency departments with haemoptysis as the primary complaint. PE diagnosis was ruled out in patients with a low pre-test probability in combination with a negative age-adjusted D-dimer (referred to as the “age-adjusted” D-dimer strategy), a negative computed tomography pulmonary angiography or when a clear alternative source of bleeding was identified, along with negative findings for venous thromboembolism during a 30-day follow-up.Results: A total of 546 patients were included in the study. The prevalence of PE, including the 30-day follow-up, was 4.2% (95% CI 2.7–6.3%). The majority of these cases (78%) exhibited distal (segmental or subsegmental) emboli and there were no PE-related fatalities. The “age-adjusted” D-dimer strategy initially excluded PE in 24% of patients (95% CI 21–28%), with a failure rate of 0.8% (95% CI 0.0–4.1%). Retrospectively applied, the “clinical probability-adjusted” D-dimer strategies, specifically the YEARS and Pulmonary Embolism Graduated d-Dimer (PEGeD) algorithms, excluded PE in a significantly higher proportion (30% and 32%, respectively) compared with the “age-adjusted” D-dimer strategy (p<0.05 for both), with similar failure rates.Conclusions: PE is infrequent among patients presenting with haemoptysis, showing segmental or subsegmental emboli distribution. The “clinical probability-adjusted” D-dimer strategies seem to have significantly higher efficiency compared with the “age-adjusted” strategy.

Background: Pneumonia is the leading cause of death from infectious diseases worldwide. Lung ultrasound (LUS) is highly accurate for chest infections diagnosis, yet its correlation with causative pathogens remains unclear. Respiratory cultures, combined with molecular techniques represent the gold standard, achieving etiological diagnosis in 90–95% of cases. We compared LUS findings with bronchoalveolar lavage (BAL) sample analyses; to our knowledge, no prior studies have investigated this in the emergency department (ED). Materials and methods: Bronchoalveolar lavage (BAL)-LUS is a prospective observational non-profit study conducted in the ED, aiming to assess whether there is a correlation between the LUS sonographic appearance, assessed blindly across 12 lung fields, and the etiopathogenetic agent of pneumonia (bacterial and viral) detected with molecular syndromic panels (MSPs) and respiratory cultures obtained with BAL. Results: 64 patients were enrolled (mean age 73.3 ± 14.6) with 11 diagnosed as viral pneumonia and 53 as bacterial pneumonia. Bacterial pneumonias were more commonly associated with consolidation (2.9 ± 2.2 vs. 1.5 ± 0.9, p < 0.01) and a higher incidence of pleural effusion (0.9 ± 1.3 vs. 0.3 ± 0.6, p < 0.01). Viral pneumonias were more often associated with interstitial syndrome (4.9 ± 3.3 vs. 0.5 ± 1.3, p < 0.01) and small subpleural consolidations (0.9 ± 1.8 vs. 0.2 ± 0.6, p = 0.01). The mean LUS score was significantly higher in bacterial than in viral pneumonia with a AUC of 0.81 (95% CI 0.68–0.93). Conclusions: Viral pneumonia is usually associated with interstitial syndrome and small subpleural consolidations; on the other hand, bacterial pneumonia is usually associated with consolidation, and pleural effusion.

Background: Pneumonia remains a major cause of morbidity and mortality worldwide. Rapid diagnostic testing with molecular syndromic panels (MSP) has proved useful for the management of antimicrobial treatment of hospital-acquired pneumonia (HAP). In this study, we evaluated the impact of early use of MSP testing in the Emergency Department (ED) for the management of antibiotic therapy in patients with moderate to severe CAP with risk factors for multi-drug-resistant pathogens (CAP-MDR). Patients and methods: Patients presenting at the ED with diagnosis of moderate to severe CAP-MDR underwent microbiological analysis of lower respiratory tract specimens by culture and MSP testing (bioMérieux, FilmArray ^® Pneumonia Plus Panel). The primary outcome was the percentage of cases in which MSP testing modified the empiric antimicrobial therapy started according to local protocols. Among the secondary outcomes we included the time elapsed from ED admission to antibiotic change or confirmation upon receipt of the MSP results. Results: Between June 2024 and May 2025, 93 patients were enrolled (age, 72.9 ± 13.9 years; 62.4% males). MSP testing identified one or more pathogens in 91.4% of cases. Modification of empiric antibiotic therapy, started according to local protocols, occurred in 65.6% of patients (escalation in 44.1% and de-escalation in 21.5% of cases) after 11.4 ± 6.3 h (IQR 12.0) since ED presentation. Conclusions: The early use of MSP on lower respiratory samples collected in the ED from patients with diagnosis of moderate to severe CAP-MDR could allow a rapid and targeted modification of the empiric antibiotic therapy in these patients, with potential advantages on antimicrobial stewardship and patient management.

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 multidrug-resistant (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. Trial registration number: NCT07425561