Prospective Clinical Assessments of Hospitalized Patients With Positive SARS-CoV-2 PCR Tests for Necessity of Isolation

Rhee, Chanu; Baker, Meghan A; Kanjilal, Sanjat; Tucker, Robert; Vaidya, Vineeta; Badwaik, Amy; Blaeser, Elizabeth Mermel; Coughlin, Cassie; Elloyan, Jennifer; Hsieh, Candace; Holtzman, Meghan; Solem, Ofelia

doi:10.1093/ofid/ofab194

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…COVID-19 hospitalizations were defined by positive SARS-CoV-2 polymerase chain reaction (PCR) tests from 3 days before admission through discharge or via institutional COVID-19 electronic medical record flags triggered by positive internal or external PCR tests. Encounters were excluded if the patient had a positive COVID-19 PCR or COVID-19 flag greater than 30 days prior to hospitalization or if the COVID-19 flag associated with the admission lasted less than 5 days, typically an indicator that the infection control team deemed infection to be resolved, remote, or a false positive result (5).…”

Section: Methodsmentioning

confidence: 99%

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Shappell

Kanjilal

Chan

et al. 2022

Critical Care Explorations

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IMPORTANCE:The prevalence and causes of sepsis in patients hospitalized with COVID-19 are poorly characterized. OBJECTIVES:To investigate the prevalence, clinical characteristics, and outcomes of sepsis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) versus other pathogens in patients hospitalized with COVID-19. DESIGN, SETTING, AND PARTICIPANTS:Cross-sectional, retrospective chart review of 200 randomly selected patients hospitalized with COVID-19 at four Massachusetts hospitals between March 2020 and March 2021. MAIN OUTCOMES AND MEASURES:The presence or absence of sepsis was determined per Sepsis-3 criteria (infection leading to an increase in Sequential Organ Failure Assessment score by ≥ 2 points above baseline). Sepsis episodes were assessed as caused by SARS-CoV-2, other pathogens, or both. Rates of organ dysfunction and in-hospital death were also assessed. RESULTS:Sepsis was present in 65 of 200 COVID-19 hospitalizations (32.5%), of which 46 of 65 sepsis episodes (70.8%) were due to SARS-CoV-2 alone, 17 of 65 (26.2%) were due to both SARS-CoV-2 and non-SARS-CoV-2 infections, and two of 65 (3.1%) were due to bacterial infection alone. SARS-CoV-2-related organ dysfunction in patients with sepsis occurred a median of 1 day after admission (interquartile range, 0-2 d) and most often presented as respiratory (93.7%), neurologic (46.0%), and/or renal (39.7%) dysfunctions. In-hospital death occurred in 28 of 200 COVID-19 hospitalizations (14.0%), including two of 135 patients without sepsis (1.5%), 16 of 46 patients with sepsis (34.8%) due to SARS-CoV-2 alone, and 10 of 17 patients with sepsis (58.8%) due to both SARS-CoV-2 and bacterial pathogens. CONCLUSIONS:Sepsis occurred in one in three patients hospitalized with COVID-19 and was primarily caused by SARS-CoV-2 itself, although bacterial infection also contributed in a quarter of sepsis cases. Mortality in COVID-19 patients with sepsis was high, especially in patients with mixed SARS-CoV-2 and bacterial sepsis. These findings affirm SARS-CoV-2 as an important cause of sepsis and highlight the need to improve surveillance, recognition, prevention, and treatment of both viral and bacterial sepsis in hospitalized patients with COVID-19.

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Section: Methodsmentioning

confidence: 99%

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Shappell

Kanjilal

Chan

et al. 2022

Critical Care Explorations

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“…1,2 Asymptomatic patients were categorized as infectious (Ct values <30 in at least 1 sample) or noninfectious if 2 samples had Ct values ≥30. 1,4 Other evidence of being noninfectious was a positive SARS-CoV2 IgG or history of a positive result in the previous 90 days.…”

mentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) incidence after exposures in shared patient rooms in a tertiary-care center in Iowa, July 2020–May 2021

Trannel

Kobayashi

Dains

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…Some of these algorithms have been shown to safely facilitate rapid discontinuation of isolation in a large fraction of SARS-CoV-2-positive patients. 31,32 However, the precise algorithm and Ct value varied between hospitals (with 30 being the lowest threshold used). Some hospitals may be reluctant to consider Ct values for infection control decisions, however, given potential variability between assays and sample quality, given the lack of a uniform standard for inferring absence of infectiousness, and because some hospitals' assays or laboratories may not generate or report Ct values.…”

Section: Discussionmentioning

confidence: 99%

Survey of coronavirus disease 2019 (COVID-19) infection control policies at leading US academic hospitals in the context of the initial pandemic surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant

Rhee

Baker

2022

Infect. Control Hosp. Epidemiol.

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Objective: To assess COVID-19 infection policies at leading U.S. medical centers in the context of the initial Omicron wave. Design: Electronic survey study eliciting hospitals’ policies on masking, personal protective equipment, cohorting, airborne infection isolation rooms (AIIRs), portable HEPA filters, and patient/employee testing. Setting and participants: Hospital epidemiologists from U.S. News top 20 hospitals and 10 hospitals in the CDC Prevention Epicenters program. Methods: Survey results were reported using descriptive statistics. Results: 23/30(77%) hospital epidemiologists completed the survey between February 15-March 3, 2022. 18(78%) hospitals used medical masks for universal masking while 5(22%) used N95 respirators. 16(70%) required universal eye protection. 22(96%) used N95s for routine COVID-19 care while 1(4%) reserved N95s for aerosol-generating procedures. 2(9%) utilized dedicated COVID-19 wards, 8(35%) used mixed COVID-19/non-COVID-19 units, and 13(57%) used both dedicated and mixed units. 4(17%) used AIIRs for all COVID-19 patients, 10(43%) prioritized AIIRs for aerosol-generating procedures, 3(13%) used alternate risk-stratification criteria, and 6(26%) did not routinely use AIIRs. 9(39%) did not use portable HEPA filters, but 14(61%) used them for various indications, most commonly as substitutes for AIIRs when unavailable or for specific high-risk areas or situations. 21(91%) tested asymptomatic patients on admission, but post-admission testing strategies and preferred specimen sites varied substantially. 5(22%) required regular testing of unvaccinated employees; 1(4%) reported mandatory weekly testing even for vaccinated employees during the Omicron surge. Conclusions: There is substantial variation in leading hospitals’ COVID-19 infection control practices. Clearer public health guidance and transparency around hospitals’ policies may facilitate more consistent national standards.

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Prospective Clinical Assessments of Hospitalized Patients With Positive SARS-CoV-2 PCR Tests for Necessity of Isolation

Cited by 14 publications

References 7 publications

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Coronavirus disease 2019 (COVID-19) incidence after exposures in shared patient rooms in a tertiary-care center in Iowa, July 2020–May 2021

Survey of coronavirus disease 2019 (COVID-19) infection control policies at leading US academic hospitals in the context of the initial pandemic surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant

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