Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Chicago Department of Public Health, Chicago, Illinois, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e416-e425. doi: 10.1093/cid/ciac405.
Patterns of shedding replication-competent severe acute respiratory syndrome coronavirus 2 (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 coronavirus disease 2019 (COVID-19).
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 viral culture and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Clinical and epidemiologic metadata were reviewed.
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 (1.5%) immunocompetent patients 10 days after symptom onset (P = .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.
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.
严重或危重新冠肺炎（COVID-19）患者中具有复制能力的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）脱落模式尚未得到很好的描述。我们研究了严重或危重新冠病毒病 2019（COVID-19）患者的上呼吸道和下呼吸道标本中具有复制能力的 SARS-CoV-2 的脱落持续时间。
我们招募了因 COVID-19 而入住三级护理医院重症监护病房（ICU）或长期急性护理医院（LTACH）的活动性或近期严重或危重新冠肺炎患者。在预定的时间间隔采集呼吸道标本，并使用病毒培养和逆转录定量聚合酶链反应（RT-qPCR）检测 SARS-CoV-2。回顾临床和流行病学元数据。
我们从 78 名患者中收集了 529 份呼吸道标本。在症状出现后 45 天内，11 名免疫功能低下患者中的 4 名（36.3%）和症状出现后 10 天内 67 名免疫功能正常患者中的 1 名（1.5%）检测到具有复制能力的病毒（P=0.001）。所有培养阳性的患者均在 ICU 队列中，并且持续或反复出现 COVID-19 症状。从症状出现到首次采集标本的中位时间为 ICU 患者 15 天（范围为 6-45 天）和 LTACH 患者 58.5 天（范围为 34-139 天）。在 50 名 ICU 患者中的 40 名（80%）和 28 名 LTACH 患者中的 7 名（25%）患者中检测到 SARS-CoV-2 RNA。
免疫功能低下和持续或反复出现的症状与具有复制能力的 SARS-CoV-2 的脱落有关，这支持除了时间之外，还需要改善呼吸道症状作为停止基于传播预防措施的标准。我们的结果表明，免疫功能正常的严重或危重新冠肺炎患者的潜在传染性期可能与报告的轻症患者相似。
