Yield of Severe Acute Respiratory Syndrome Coronavirus 2 Lower Respiratory Tract Testing After a Negative Nasopharyngeal Test Among Hospitalized Persons Under Investigation for Coronavirus Disease 2019

Egbuonu, Kenechukwu; Hyle, Emily P; Hurtado, Rocio; Alba, George A.; Zachary, Kimon C.; Branda, John A.; Hibbert, Kathryn A.; Hooper, David C.; Shenoy, Erica S.; Turbett, Sarah E; Dugdale, Caitlin M

doi:10.1093/ofid/ofab257

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…However, the emergency approval of remdesivir for the treatment of COVID‐19 was mainly based on clinical outcomes. The first evidence of an increased viral decay in patients treated with remdesivir compared to those nontreated with the drug was showed by Regan and colleagues in a sample of 51 patients, 18 of whom treated with remdesivir 13 . Even Dubert and colleagues published a case series reporting that remdesivir was able to reduce viral load in four out of five treated patients 16 .…”

Section: Discussionmentioning

confidence: 99%

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Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

Biancofiore

Mirijello

Puteo

et al. 2022

Journal of Medical Virology

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Remdesivir is a broad‐spectrum antiviral agent able to inhibit the RNA polymerase of SARS‐CoV‐2. At present, studies focusing on the effect of remdesivir on viral load (VL) are few and with contrasting results. Aim of the present study was to evaluate the effect of remdesivir on SARS‐CoV‐2 VL from nasopharyngeal swabs (cycle threshold criterion) in a sample of patients treated with the drug, compared with patients who did not receive the antiviral treatment. This retrospective analysis evaluated patients with (1) real‐time polymerase chain reaction (RT‐PCR) confirmed COVID‐19 diagnosis and (2) availability of at least two positive nasopharyngeal swabs analysed with the same analytic platform (ORF target gene, Ingenius ELITe, ELITechGroup, Puteaux, France). Upper respiratory specimens from nasopharyngeal swabs were collected at admission (T0) and 7–14 days after treatment, upon clinical decision. A total of 27 patients treated with remdesivir (Group A) met the inclusion criteria and were compared with 18 patients (Group B) treated with standard care, matched for baseline clinical characteristics. At baseline, both remdesivir‐treated and nontreated patients showed comparable VLs (21.73 ± 6.81 vs. 19.27 ± 5.24, p = 0.348). At the second swab, remdesivir‐treated patients showed a steeper VL reduction with respect to controls (34.28 ± 7.73 vs. 27.22 ± 3.92; p < 0.001). Longitudinal linear model estimated a mean decrease in cycle threshold equal to 0.61 (SE: 0.09) per day in remdesivir‐treated versus 0.33 (SE: 0.10) per day in remdesivir nontreated patients (p for heterogeneity = 0.045). The present study shows that the administration of remdesivir in hospitalized COVID‐19 patients significantly reduces the VL on nasopharyngeal swabs.

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Section: Discussionmentioning

confidence: 99%

“…In addition, evidences on the correlation between VL and clinical severity are controversial, 9–11 even if it has been shown that patients with more severe disease could present with a slower VL clearance 7 . At present, studies focusing on the effect of remdesivir on VL are few and with contrasting results 9,12,13 …”

Section: Introductionmentioning

confidence: 99%

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

Biancofiore

Mirijello

Puteo

et al. 2022

Journal of Medical Virology

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“…50 The number of patients who test positive on repeat testing tends to be low, although this varies in accordance with the incidence of infections in the broader community. 83 The cases that are detected, however, tend to be high yield, since new-onset infections are typically the most contagious infections with very high viral loads even in the absence of symptoms. 67 These are the patients most likely to transmit to other patients or to staff.…”

Section: Symptom Screening and Universal Testingmentioning

confidence: 99%

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Klompas

2022

Semin Respir Crit Care Med

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A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.

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Duration of Replication-Competent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Shedding Among Patients With Severe or Critical Coronavirus Disease 2019 (COVID-19)

Kim

Lin

Jennings

et al. 2022

Clinical Infectious Diseases

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Background 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). 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 viral culture and reverse transcription–quantitative polymerase chain reaction (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 (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. 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.

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Yield of Severe Acute Respiratory Syndrome Coronavirus 2 Lower Respiratory Tract Testing After a Negative Nasopharyngeal Test Among Hospitalized Persons Under Investigation for Coronavirus Disease 2019

Cited by 3 publications

References 16 publications

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Duration of Replication-Competent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Shedding Among Patients With Severe or Critical Coronavirus Disease 2019 (COVID-19)

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