tetano
Editor, Senior Moderator
Clin Infect Dis
. 2022 May 24;ciac405.
doi: 10.1093/cid/ciac405. Online ahead of print.
Duration of replication-competent SARS-CoV-2 shedding among patients with severe or critical coronavirus disease 2019 (COVID-19)
Do Young Kim[SUP] 1 [/SUP], Michael Y Lin[SUP] 2 [/SUP], Cheryl Jennings[SUP] 3 [/SUP], Haiying Li[SUP] 4 [/SUP], Jae Hyung Jung[SUP] 5 [/SUP], Nicholas M Moore[SUP] 6 [/SUP], Isaac Ghinai[SUP] 7 [/SUP], Stephanie R Black[SUP] 7 [/SUP], Daniel J Zaccaro[SUP] 8 [/SUP], John Brofman[SUP] 9 [/SUP], Mary K Hayden[SUP] 2 [/SUP], CDC Prevention Epicenter Program
Affiliations
Abstract
Background: Patterns of shedding replication-competent SARS-CoV-2 in severe or critical COVID-19 are not well-characterized. We investigated the duration of replication-competent SARS-CoV-2 shedding in upper and lower airway specimens from patients with severe or critical COVID-19.
Methods: We enrolled patients with active or recent severe or critical COVID-19 who were admitted to a tertiary care hospital intensive care unit (ICU) or long-term acute care hospital (LTACH) because of COVID-19. Respiratory specimens were collected at predefined intervals and tested for SARS-CoV-2 using virus culture and RT-qPCR. Clinical and epidemiologic metadata were reviewed.
Results: We collected 529 respiratory specimens from 78 patients. Replication-competent virus was detected in 4 of 11 (36.3%) immunocompromised patients up to 45 days after symptom onset, and in 1 of 67 (14.9%) immunocompetent patients 10 days after symptom onset (P = 0.001). All culture-positive patients were in the ICU cohort and had persistent or recurrent symptoms of COVID-19. Median time from symptom onset to first specimen collection was 15 days (range, 6-45) for ICU patients and 58.5 days (range, 34-139) for LTACH patients. SARS-CoV-2 RNA was detected in 40 of 50 (80%) ICU patients and 7 of 28 (25%) LTACH patients.
Conclusions: Immunocompromise and persistent or recurrent symptoms were associated with shedding of replication-competent SARS-CoV-2, supporting the need for improving respiratory symptoms in addition to time as criteria for discontinuation of transmission-based precautions. Our results suggest that the period of potential infectiousness among immunocompetent patients with severe or critical COVID-19 may be similar to that reported for patients with milder disease.
Keywords: SARS-CoV-2; intensive care; long-term acute care hospital; virus culture; virus shedding.
. 2022 May 24;ciac405.
doi: 10.1093/cid/ciac405. Online ahead of print.
Duration of replication-competent SARS-CoV-2 shedding among patients with severe or critical coronavirus disease 2019 (COVID-19)
Do Young Kim[SUP] 1 [/SUP], Michael Y Lin[SUP] 2 [/SUP], Cheryl Jennings[SUP] 3 [/SUP], Haiying Li[SUP] 4 [/SUP], Jae Hyung Jung[SUP] 5 [/SUP], Nicholas M Moore[SUP] 6 [/SUP], Isaac Ghinai[SUP] 7 [/SUP], Stephanie R Black[SUP] 7 [/SUP], Daniel J Zaccaro[SUP] 8 [/SUP], John Brofman[SUP] 9 [/SUP], Mary K Hayden[SUP] 2 [/SUP], CDC Prevention Epicenter Program
Affiliations
- PMID: 35607802
- DOI: 10.1093/cid/ciac405
Abstract
Background: Patterns of shedding replication-competent SARS-CoV-2 in severe or critical COVID-19 are not well-characterized. We investigated the duration of replication-competent SARS-CoV-2 shedding in upper and lower airway specimens from patients with severe or critical COVID-19.
Methods: We enrolled patients with active or recent severe or critical COVID-19 who were admitted to a tertiary care hospital intensive care unit (ICU) or long-term acute care hospital (LTACH) because of COVID-19. Respiratory specimens were collected at predefined intervals and tested for SARS-CoV-2 using virus culture and RT-qPCR. Clinical and epidemiologic metadata were reviewed.
Results: We collected 529 respiratory specimens from 78 patients. Replication-competent virus was detected in 4 of 11 (36.3%) immunocompromised patients up to 45 days after symptom onset, and in 1 of 67 (14.9%) immunocompetent patients 10 days after symptom onset (P = 0.001). All culture-positive patients were in the ICU cohort and had persistent or recurrent symptoms of COVID-19. Median time from symptom onset to first specimen collection was 15 days (range, 6-45) for ICU patients and 58.5 days (range, 34-139) for LTACH patients. SARS-CoV-2 RNA was detected in 40 of 50 (80%) ICU patients and 7 of 28 (25%) LTACH patients.
Conclusions: Immunocompromise and persistent or recurrent symptoms were associated with shedding of replication-competent SARS-CoV-2, supporting the need for improving respiratory symptoms in addition to time as criteria for discontinuation of transmission-based precautions. Our results suggest that the period of potential infectiousness among immunocompetent patients with severe or critical COVID-19 may be similar to that reported for patients with milder disease.
Keywords: SARS-CoV-2; intensive care; long-term acute care hospital; virus culture; virus shedding.