The proportion of RV involvement in CAP is higher than previously reported. The proportion of RV identified in healthy subjects is significantly lower than in CAP, but it is not zero and should be weighed when interpreting corresponding proportions among patients.

The optimal method for identifying respiratory viruses in adults has not been established. The objective of the study was to compare the sensitivities of three sampling methods for this purpose. One thousand participants (mean age, 63.1 ؎ 17.8 years) were included. Of these, 550 were patients hospitalized for acute febrile lower respiratory tract infections and 450 were controls. Oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), and nasopharyngeal washings (NPW) were obtained from each participant and were tested for 12 respiratory viruses by a multiplex hydrolysis probes-based quantitative real-time reverse transcription-PCR. Patients were defined as positive for a specific virus if the virus was identified by at least one sampling method. In all, 251 viruses were identified in 244 participants. For the detection of any virus, the sensitivity rates for OPS, NPS, and NPW were 54.2%, 73.3%, and 84.9%, respectively (for OPS versus NPS and NPW, P < 0.00001; for NPS versus NPW, P < 0.003). Maximal sensitivity was obtained only with sampling by all three methods. The same gradation of sensitivity for the three sampling methods was found when influenza viruses, coronaviruses, and rhinoviruses were analyzed separately. The three sampling methods yielded equal sensitivity rates for respiratory syncytial virus. We conclude that nasopharyngeal sampling has a higher rate of sensitivity than oropharyngeal sampling and that the use of NPW has a higher rate of sensitivity than the use of NPS with a rigid cotton swab for the identification of respiratory viruses in adults. Sampling by all three methods is required for the maximal detection of respiratory viruses.

IntroductionMany mechanically ventilated elderly patients in Israel are treated outside of intensive care units (ICUs). The decision as to whether these patients should be treated in ICUs is reached without clear guidelines. We therefore conducted a study with the aim of identifying triage criteria and factors associated with in-hospital mortality in this population.MethodsAll mechanically invasive ventilated elderly (65+) medical patients in the hospital were included in a prospective, non-interventional, observational study.ResultsOf the 579 ventilations, 283 (48.9%) were done in ICUs compared with 296 (51.1%) in non-ICU wards. The percentage of ICU ventilations in the 65 to 74, 75 to 84, and 85+ age groups was 62%, 45%, and 23%, respectively. The decision to ventilate in ICUs was significantly and independently influenced by age (Odds Ratio (OR) = 0.945, P < 0.001), and pre-hospitalization functional status by functional independence measure (FIM) scale (OR = 1.054, P < 0.001). In-hospital mortality was 53.0% in ICUs compared with 68.2% in non-ICU wards (P < 0.001), but the rate was not independently and significantly affected by hospitalization in ICUs.ConclusionsIn Israel, most elderly patients are ventilated outside ICUs and the percentage of ICU ventilations decreases as age increases. In our study groups, the lower mortality among elderly patients ventilated in ICUs is related to patient characteristics and not to their treatment in ICUs per se. Although the milieu in which this study was conducted is uncommon today in the western world, its findings point to possible means of managing future situations in which the demand for mechanical ventilation of elderly patients exceeds the supply of intensive care beds. Moreover, the findings of this study can contribute to the search for ways to reduce costs without having a negative effect on outcome in ventilated elderly patients.