Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period

{ 'indexed': {'date-parts': [[2023, 5, 6]], 'date-time': '2023-05-06T04:26:27Z', 'timestamp': 1683347187963}, 'reference-count': 36, 'publisher': 'MDPI AG', 'issue': '2', 'license': [ { 'start': { 'date-parts': [[2023, 5, 4]], 'date-time': '2023-05-04T00:00:00Z', 'timestamp': 1683158400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'abstract': '<jats:p>Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) ribonucleic acid ' '(RNA) shedding is an important parameter for determining the optimal length of isolation ' 'period required for coronavirus disease 2019 (COVID-19) patients. However, the clinical ' '(i.e., patient and disease) characteristics that could influence this parameter have yet to ' 'be determined. In this study, we aim to explore the potential associations between several ' 'clinical features and the duration of SARS-CoV-2 RNA shedding in patients hospitalized with ' 'COVID-19. A retrospective cohort study involving 162 patients hospitalized for COVID-19 in a ' 'tertiary referral teaching hospital in Indonesia was performed from June to December 2021. ' 'Patients were grouped based on the mean duration of viral shedding and were compared based on ' 'several clinical characteristics (e.g., age, sex, comorbidities, COVID-19 symptoms, severity, ' 'and therapies). Subsequently, clinical factors potentially associated with the duration of ' 'SARS-CoV-2 RNA shedding were further assessed using multivariate logistic regression ' 'analysis. As a result, the mean duration of SARS-CoV-2 RNA shedding was found to be 13 ± 8.44 ' 'days. In patients with diabetes mellitus (without chronic complications) or hypertension, the ' 'duration of viral shedding was significantly prolonged (≥13 days; p = 0.001 and p = 0.029, ' 'respectively). Furthermore, patients with dyspnea displayed viral shedding for longer ' 'durations (p = 0.011). The multivariate logistic regression analysis reveals that independent ' 'risk factors associated with the duration of SARS-CoV-2 RNA shedding include disease severity ' '(adjusted odds ratio [aOR] = 2.94; 95% CI = 1.36–6.44), bilateral lung infiltrates (aOR = ' '2.79; 95% CI = 1.14–6.84), diabetes mellitus (aOR = 2.17; 95% CI = 1.02–4.63), and antibiotic ' 'treatment (aOR = 3.66; 95% CI = 1.74–7.71). In summary, several clinical factors are linked ' 'with the duration of SARS-CoV-2 RNA shedding. Disease severity is positively associated with ' 'the duration of viral shedding, while bilateral lung infiltrates, diabetes mellitus, and ' 'antibiotic treatment are negatively linked with the duration of viral shedding. Overall, our ' 'findings suggest the need to consider different isolation period estimations for specific ' 'clinical characteristics of patients with COVID-19 that affect the duration of SARS-CoV-2 RNA ' 'shedding.</jats:p>', 'DOI': '10.3390/pathophysiology30020016', 'type': 'journal-article', 'created': {'date-parts': [[2023, 5, 5]], 'date-time': '2023-05-05T08:55:50Z', 'timestamp': 1683276950000}, 'page': '186-198', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral ' 'Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation ' 'Period', 'prefix': '10.3390', 'volume': '30', 'author': [ { 'given': 'Muhammad Vitanata', 'family': 'Arfijanto', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'ORCID': 'http://orcid.org/0000-0001-9869-5098', 'authenticated-orcid': False, 'given': 'Tri Pudy', 'family': 'Asmarawati', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}, { 'name': 'Universitas Airlangga Hospital, Airlangga University, Surabaya ' '60115, Indonesia'}]}, { 'given': 'Bramantono', 'family': 'Bramantono', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'ORCID': 'http://orcid.org/0000-0002-4834-2259', 'authenticated-orcid': False, 'given': 'Musofa', 'family': 'Rusli', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'given': 'Brian Eka', 'family': 'Rachman', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}, { 'name': 'Universitas Airlangga Hospital, Airlangga University, Surabaya ' '60115, Indonesia'}]}, { 'ORCID': 'http://orcid.org/0000-0001-6634-6088', 'authenticated-orcid': False, 'given': 'Bagus Aulia', 'family': 'Mahdi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'given': 'Nasronudin', 'family': 'Nasronudin', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}, { 'name': 'Universitas Airlangga Hospital, Airlangga University, Surabaya ' '60115, Indonesia'}]}, { 'given': 'Usman', 'family': 'Hadi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}], 'member': '1968', 'published-online': {'date-parts': [[2023, 5, 4]]}, 'reference': [ { 'key': 'ref_1', 'unstructured': '(2023, March 01). Weekly Epidemiological Update on COVID-19—1 March ' '2023. Available online: ' 'https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---1-march-2023.'}, { 'key': 'ref_2', 'unstructured': '(2023, March 12). Infeksi Emerging Kementerian Kesehatan RI. Available ' 'online: https://infeksiemerging.kemkes.go.id/dashboard/covid-19.'}, { 'key': 'ref_3', 'doi-asserted-by': 'crossref', 'first-page': '506', 'DOI': '10.1002/jmv.26280', 'article-title': 'Duration of SARS-CoV-2 RNA shedding and factors associated with ' 'prolonged viral shedding in patients with COVID-19', 'volume': '93', 'author': 'Li', 'year': '2020', 'journal-title': 'J. Med. Virol.'}, { 'key': 'ref_4', 'doi-asserted-by': 'crossref', 'first-page': '2240', 'DOI': '10.1093/cid/ciaa451', 'article-title': 'Duration of Viral Shedding of Discharged Patients With Severe COVID-19', 'volume': '71', 'author': 'Zhou', 'year': '2020', 'journal-title': 'Clin. Infect. Dis.'}, { 'key': 'ref_5', 'doi-asserted-by': 'crossref', 'first-page': '5235', 'DOI': '10.1172/JCI138759', 'article-title': 'Kinetics of viral load and antibody response in relation to COVID-19 ' 'severity', 'volume': '130', 'author': 'Wang', 'year': '2020', 'journal-title': 'J. Clin. Investig.'}, { 'key': 'ref_6', 'doi-asserted-by': 'crossref', 'first-page': '2001190', 'DOI': '10.1183/13993003.01190-2020', 'article-title': 'Risk factors for viral RNA shedding in COVID-19 patients', 'volume': '56', 'author': 'Fu', 'year': '2020', 'journal-title': 'Eur. Respir. J.'}, { 'key': 'ref_7', 'doi-asserted-by': 'crossref', 'first-page': '2086', 'DOI': '10.1007/s42399-020-00499-3', 'article-title': 'A Review of Viral Shedding in Resolved and Convalescent COVID-19 ' 'Patients', 'volume': '2', 'author': 'Karia', 'year': '2020', 'journal-title': 'SN Compr. Clin. Med.'}, { 'key': 'ref_8', 'doi-asserted-by': 'crossref', 'first-page': '178', 'DOI': '10.1016/j.ijid.2021.10.045', 'article-title': 'COVID-19 in an immunocompromised host: Persistent shedding of viable ' 'SARS-CoV-2 and emergence of multiple mutations: A case report', 'volume': '114', 'author': 'Leung', 'year': '2021', 'journal-title': 'Int. J. Infect. Dis.'}, { 'key': 'ref_9', 'doi-asserted-by': 'crossref', 'first-page': 'acmi000133', 'DOI': '10.1099/acmi.0.000133', 'article-title': 'Prolonged viral shedding and new mutations of COVID-19 could complicate ' 'the control of the pandemic', 'volume': '2', 'author': 'Chen', 'year': '2020', 'journal-title': 'Access Microbiol.'}, { 'key': 'ref_10', 'doi-asserted-by': 'crossref', 'first-page': '103462', 'DOI': '10.1016/j.amsu.2022.103462', 'article-title': 'National early warning score (NEWS) 2 predicts hospital mortality from ' 'COVID-19 patients', 'volume': '76', 'author': 'Wibisono', 'year': '2022', 'journal-title': 'Ann. Med. Surg.'}, { 'key': 'ref_11', 'doi-asserted-by': 'crossref', 'first-page': '73', 'DOI': '10.12688/f1000research.45046.1', 'article-title': 'Optimal use of tocilizumab for severe and critical COVID-19: A ' 'systematic review and meta-analysis', 'volume': '10', 'author': 'Nugroho', 'year': '2021', 'journal-title': 'F1000Research'}, { 'key': 'ref_12', 'doi-asserted-by': 'crossref', 'first-page': '4046', 'DOI': '10.1016/j.vaccine.2022.05.059', 'article-title': 'Hypertension is asso-ciated with antibody response and breakthrough ' 'infection in health care workers following vaccination with inactivated ' 'SARS-CoV-2', 'volume': '40', 'author': 'Soegiarto', 'year': '2022', 'journal-title': 'Vaccine'}, { 'key': 'ref_13', 'doi-asserted-by': 'crossref', 'first-page': '466', 'DOI': '10.5005/jp-journals-10071-24170', 'article-title': 'Predictive Value of Sequential Organ Failure Assessment, Quick ' 'Sequential Organ Failure Assessment, Acute Physiology and Chronic ' 'Health Evaluation II, and New Early Warning Signs Scores Estimate ' 'Mortality of COVID-19 Patients Requiring Intensive Care Unit', 'volume': '26', 'author': 'Asmarawati', 'year': '2022', 'journal-title': 'Indian J. Crit. Care Med.'}, { 'key': 'ref_14', 'doi-asserted-by': 'crossref', 'first-page': '1', 'DOI': '10.12688/f1000research.31645.1', 'article-title': 'The clinical impact of bacterial co-infection among moderate, severe ' 'and critically ill COVID-19 patients in the second referral hospital in ' 'Surabaya', 'volume': '10', 'author': 'Asmarawati', 'year': '2021', 'journal-title': 'F1000Research'}, { 'key': 'ref_15', 'unstructured': 'Burhan, E., Susanto, A.D., \ufeffIsbaniah, F., Sally, A.N., Eka, G., ' 'Ceva, W.P., Susilo, A., Firdaus, I., Santoso, A., and Juzar, D.A. ' '(2020). Pedoman Tatalaksana COVID-19, IDAI. [3rd ed.].'}, { 'key': 'ref_16', 'doi-asserted-by': 'crossref', 'first-page': '531', 'DOI': '10.1016/j.ijid.2020.05.045', 'article-title': 'Factors associated with the duration of viral shedding in adults with ' 'COVID-19 outside of Wuhan, China: A retrospective cohort study', 'volume': '96', 'author': 'Qi', 'year': '2020', 'journal-title': 'Int. J. Infect. Dis.'}, { 'key': 'ref_17', 'doi-asserted-by': 'crossref', 'first-page': '799', 'DOI': '10.1093/cid/ciaa351', 'article-title': 'Factors Associated With Prolonged Viral RNA Shedding in Patients with ' 'Coronavirus Disease 2019 (COVID-19)', 'volume': '71', 'author': 'Xu', 'year': '2020', 'journal-title': 'Clin. Infect. Dis.'}, { 'key': 'ref_18', 'doi-asserted-by': 'crossref', 'first-page': '1069', 'DOI': '10.14336/AD.2020.0630', 'article-title': 'Clinical Factors Associated with Progression and Prolonged Viral ' 'Shedding in COVID-19 Patients: A Multicenter Study', 'volume': '11', 'author': 'Feng', 'year': '2020', 'journal-title': 'Aging Dis.'}, { 'key': 'ref_19', 'doi-asserted-by': 'crossref', 'first-page': '1054', 'DOI': '10.1016/S0140-6736(20)30566-3', 'article-title': 'Clinical course and risk factors for mortality of adult inpatients with ' 'COVID-19 in Wuhan, China: A retrospective cohort study', 'volume': '395', 'author': 'Zhou', 'year': '2020', 'journal-title': 'Lancet'}, { 'key': 'ref_20', 'doi-asserted-by': 'crossref', 'first-page': '1995', 'DOI': '10.2147/IDR.S261159', 'article-title': 'Indicators of Critical Illness and Predictors of Mortality in COVID-19 ' 'Patients', 'volume': '13', 'author': 'Aly', 'year': '2020', 'journal-title': 'Infect. Drug Resist.'}, { 'key': 'ref_21', 'doi-asserted-by': 'crossref', 'first-page': '104364', 'DOI': '10.1016/j.jcv.2020.104364', 'article-title': 'Clinical features and short-term outcomes of 221 patients with COVID-19 ' 'in Wuhan, China', 'volume': '127', 'author': 'Zhang', 'year': '2020', 'journal-title': 'J. Clin. Virol.'}, { 'key': 'ref_22', 'first-page': '22399', 'article-title': 'Impact of age on duration of viral RNA shedding in patients with ' 'COVID-19', 'volume': '12', 'author': 'Zhou', 'year': '2020', 'journal-title': 'Aging'}, { 'key': 'ref_23', 'doi-asserted-by': 'crossref', 'first-page': '53', 'DOI': '10.1186/s13293-020-00330-7', 'article-title': 'Sex differences in severity and mortality from COVID-19: Are males more ' 'vulnerable?', 'volume': '11', 'author': 'Pradhan', 'year': '2020', 'journal-title': 'Biol. Sex Differ.'}, { 'key': 'ref_24', 'doi-asserted-by': 'crossref', 'first-page': '665064', 'DOI': '10.3389/fphys.2021.665064', 'article-title': 'COVID-19 and Hypertension: The What, the Why, and the How', 'volume': '12', 'author': 'Muhamad', 'year': '2021', 'journal-title': 'Front. Physiol.'}, { 'key': 'ref_25', 'doi-asserted-by': 'crossref', 'first-page': '454', 'DOI': '10.1007/s12020-020-02465-4', 'article-title': 'Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral ' 'shedding in lower respiratory tract samples of critically ill patients', 'volume': '70', 'author': 'Buetti', 'year': '2020', 'journal-title': 'Endocrine'}, { 'key': 'ref_26', 'doi-asserted-by': 'crossref', 'first-page': '437', 'DOI': '10.1016/j.cmet.2020.07.007', 'article-title': 'Elevated Glucose Levels Favor SARS-CoV-2 Infection and Monocyte ' 'Response through a HIF-1α/Glycolysis-Dependent Axis', 'volume': '32', 'author': 'Codo', 'year': '2020', 'journal-title': 'Cell Metab.'}, { 'key': 'ref_27', 'doi-asserted-by': 'crossref', 'first-page': 'e23923', 'DOI': '10.1002/jcla.23923', 'article-title': 'Risk factors for prolonged virus shedding of respiratory tract and ' 'fecal in adults with severe acute respiratory syndrome coronavirus-2 ' 'infection', 'volume': '35', 'author': 'Zhang', 'year': '2021', 'journal-title': 'J. Clin. Lab. Anal.'}, { 'key': 'ref_28', 'doi-asserted-by': 'crossref', 'first-page': '1', 'DOI': '10.3389/fmed.2021.760170', 'article-title': 'Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution ' 'in a Mildly Affected Symptomatic Patient', 'volume': '8', 'author': 'Cunha', 'year': '2021', 'journal-title': 'Front. Med.'}, { 'key': 'ref_29', 'doi-asserted-by': 'crossref', 'first-page': '46', 'DOI': '10.1186/s12981-020-00301-3', 'article-title': 'Case report: One case of coronavirus disease 2019 (COVID-19) in a ' 'patient co-infected by HIV with a normal CD4+ T cell count', 'volume': '17', 'author': 'Menghua', 'year': '2020', 'journal-title': 'AIDS Res. Ther.'}, { 'key': 'ref_30', 'doi-asserted-by': 'crossref', 'first-page': '1397', 'DOI': '10.1002/ccr3.3786', 'article-title': 'COVID-19: Prolonged viral shedding in an HIV patient with literature ' 'review of risk factors for prolonged viral shedding and its ' 'implications for isolation strategies', 'volume': '9', 'author': 'Yousaf', 'year': '2021', 'journal-title': 'Clin. Case Rep.'}, { 'key': 'ref_31', 'doi-asserted-by': 'crossref', 'first-page': 'e000396', 'DOI': '10.1136/lupus-2020-000396', 'article-title': 'Thoughts on COVID-19 and autoimmune diseases', 'volume': '7', 'author': 'Askanase', 'year': '2020', 'journal-title': 'Lupus Sci. Med.'}, { 'key': 'ref_32', 'doi-asserted-by': 'crossref', 'first-page': '998', 'DOI': '10.1038/s41366-021-00776-8', 'article-title': 'Obesity in COVID-19 era, implications for mechanisms, comorbidities, ' 'and prognosis: A review and meta-analysis', 'volume': '45', 'author': 'Aghili', 'year': '2021', 'journal-title': 'Int. J. Obes.'}, { 'key': 'ref_33', 'doi-asserted-by': 'crossref', 'first-page': '899', 'DOI': '10.1007/s00109-021-02072-4', 'article-title': 'Obesity and its impact on COVID-19', 'volume': '99', 'author': 'Wellen', 'year': '2021', 'journal-title': 'J. Mol. Med.'}, { 'key': 'ref_34', 'doi-asserted-by': 'crossref', 'first-page': '167', 'DOI': '10.1186/s13613-020-00783-4', 'article-title': 'Protracted viral shedding and viral load are associated with ICU ' 'mortality in Covid-19 patients with acute respiratory failure', 'volume': '10', 'author': 'Bitker', 'year': '2020', 'journal-title': 'Ann. Intensiv. Care'}, { 'key': 'ref_35', 'doi-asserted-by': 'crossref', 'first-page': '833', 'DOI': '10.1111/irv.12065', 'article-title': 'Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 ' 'influenza virus in patients treated with oseltamivir for 5 days', 'volume': '7', 'author': 'Ryoo', 'year': '2012', 'journal-title': 'Influenza Other Respir. Viruses'}, { 'key': 'ref_36', 'doi-asserted-by': 'crossref', 'first-page': '1622', 'DOI': '10.1016/j.cmi.2020.07.016', 'article-title': 'Bacterial co-infection and secondary infection in patients with ' 'COVID-19: A living rapid review and meta-analysis', 'volume': '26', 'author': 'Langford', 'year': '2020', 'journal-title': 'Clin. Microbiol. Infect.'}], 'container-title': 'Pathophysiology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.mdpi.com/1873-149X/30/2/16/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 5, 5]], 'date-time': '2023-05-05T09:45:35Z', 'timestamp': 1683279935000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.mdpi.com/1873-149X/30/2/16'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 5, 4]]}, 'references-count': 36, 'journal-issue': {'issue': '2', 'published-online': {'date-parts': [[2023, 6]]}}, 'alternative-id': ['pathophysiology30020016'], 'URL': 'http://dx.doi.org/10.3390/pathophysiology30020016', 'relation': {}, 'ISSN': ['1873-149X'], 'subject': ['General Medicine'], 'container-title-short': 'Pathophysiology', 'published': {'date-parts': [[2023, 5, 4]]}}