Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critica
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ORIGINAL ARTICLE
Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients Niccolò Buetti1,2,3 Pierpaolo Trimboli 4,5 Timothy Mazzuchelli1 Elia Lo Priore6,7 Carlo Balmelli6,7 Alexandra Trkola8 Marco Conti1 Gladys Martinetti9 Luigia Elzi1,10 Alessandro Ceschi4,11,12 Vera Consonni1 Adam Ogna1 Valentina Forni-Ogna1,4 Enos Bernasconi7 ●
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Received: 21 June 2020 / Accepted: 19 August 2020 © The Author(s) 2020
Abstract Purpose The length of time a critically ill coronavirus disease 2019 (COVID-19) patient remains infectious and should therefore be isolated remains unknown. This prospective study was undertaken in critically ill patients to evaluate the reliability of single negative real-time polymerase chain reaction (RT-PCR) in lower tracheal aspirates (LTA) in predicting a second negative test and to analyze clinical factors potentially influencing the viral shedding. Methods From April 9, 2020 onwards, intubated COVID-19 patients treated in the intensive care unit were systematically evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR of nasopharyngeal swabs and LTA. The time to negativity was defined as the time between the onset of symptoms and the viral clearance in LTA. In order to identify risk factors for prolonged viral shedding, we used univariate and multivariate Cox proportional hazards models. Results Forty-eight intubated SARS-CoV-2 patients were enrolled. Overall, we observed that the association of the first negative RT-PCR with a second negative result was 96.7%. Median viral shedding was 25 (IQR: 21.5–28) days since symptoms’ onset. In the univariate Cox model analysis, type 2 diabetes mellitus was associated with a prolonged viral RNA shedding (hazard ratio [HR]: 0.41, 95% CI: 0.06–3.11, p = 0.04). In the multivariate Cox model analysis, type 2 diabetes was associated with a prolonged viral RNA shedding (HR: 0.31, 95% CI: 0.11–0.89, p = 0.029). Conclusion Intubated patients with type 2 diabetes mellitus may have prolonged SARS-CoV-2 shedding. In critically ill COVID-19 patients, one negative LTA should be sufficient to assess and exclude infectivity. Keywords Viral shedding Infectivity COVID-19 SARS-CoV-2 Intensive care unit Type 2 diabetes mellitus ●
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These authors contributed equally: Niccolò Buetti, Pierpaolo Trimboli * Pierpaolo Trimboli [email protected] 1
Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland
2
University of Paris, INSERM IAME, U1137, Team DeSCID, Paris, France
3
Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
4
Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
5
Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland,
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