COVID-19: viral shedding is prolonged in intubated patients with T2D

  • Buetti N & al.
  • Endocrine
  • 08/09/2020

  • Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Intubated patients with type 2 diabetes (T2D) may have prolonged SARS-CoV-2 shedding.
  • In critically ill patients with COVID-19, 1 negative lower tracheal aspirate (LTA) should suffice to assess and exclude infectivity.

Why this matters

  • Critically ill patients with COVID-19 must be strictly isolated to limit transmission, but duration of infectivity remains unknown.

Study design

  • Beginning April 9, 2020, 48 intubated patients with COVID-19 underwent 2-8 PCR reaction tests of nasopharyngeal swabs and LTA.
  • Funding: Swiss National Science Foundation; Bangerter-Rhyner Foundation.

Key results

  • At screening, swab and LTA results corresponded in 31 patients (65%), whereas in 15 (31%), LTA samples were positive and swabs were negative.
  • During follow-up, 31 patients had 1 negative PCR in LTA and 28 (90.3%) had a second negative test within 3 days.
  • Association of first negative PCR with second negative result was 96.7%.
  • Median viral shedding: 25 (interquartile range, 21.5-28) days since symptom onset.
  • In multivariate analysis, T2D was associated with prolonged viral RNA shedding (HR, 0.31; P=.029).
  • Similar results with negativity defined as 2 negative LTA samples (HR, 0.23; P=.0089).

Limitations

  • Observational design.
  • LTA samples were not collected daily or after 2 negative results.
  • Viral cell cultures were not routinely performed.
  • Small sample size.