tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Apr 16;8(6)
fab193.
doi: 10.1093/ofid/ofab193. eCollection 2021 Jun.
Clinical and Virologic Characteristics and Outcomes of Coronavirus Disease 2019 at a Cancer Center
Leah H Yoke[SUP] 1 2 [/SUP], Juhye M Lee[SUP] 1 [/SUP], Elizabeth M Krantz[SUP] 1 [/SUP], Jessica Morris[SUP] 1 [/SUP], Sara Marquis[SUP] 1 [/SUP], Pooja Bhattacharyya[SUP] 1 2 [/SUP], Lisa So[SUP] 1 2 [/SUP], Francis X Riedo[SUP] 3 [/SUP], Jason Simmons[SUP] 2 4 [/SUP], Ali Raza Khaki[SUP] 5 6 7 [/SUP], Guang-Shing Cheng[SUP] 5 8 [/SUP], Alexander L Greninger[SUP] 1 9 [/SUP], Steven A Pergam[SUP] 1 2 [/SUP], Alpana Waghmare[SUP] 1 10 11 [/SUP], Chikara Ogimi[SUP] 1 10 11 [/SUP], Catherine Liu[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: High morbidity and mortality have been observed in patients with cancer and coronavirus disease 2019 (COVID-19); however, there are limited data on antimicrobial use, coinfections, and viral shedding.
Methods: We conducted a retrospective cohort study of adult patients at the Seattle Cancer Care Alliance diagnosed with COVID-19 between February 28, 2020 and June 15, 2020 to characterize antimicrobial use, coinfections, viral shedding, and outcomes within 30 days after diagnosis. Cycle threshold values were used as a proxy for viral load. We determined viral clearance, defined as 2 consecutive negative results using severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction results through July 30, 2020.
Results: Seventy-one patients were included with a median age of 61 years; 59% had a solid tumor. Only 3 patients had documented respiratory bacterial coinfection. Empiric antibiotics for pneumonia were prescribed more frequently early in the study period (February 29-March 28, 2020; 12/34) compared to the later period (March 29-June 15, 2020; 2/36) (P = .002). The median number of days from symptom onset to viral clearance was 37 days with viral load rapidly declining in the first 7-10 days after symptom onset. Within 30 days of diagnosis, 29 (41%) patients were hospitalized and 12 (17%) died. Each additional comorbidity was associated with 45% lower odds of days alive and out of hospital in the month following diagnosis in adjusted models.
Conclusions: Patients at a cancer center, particularly those with multiple comorbidities, are at increased risk of poor outcomes from COVID-19. Prolonged viral shedding is frequently observed among cancer patients, and its implications on transmission and treatment strategies warrant further study.
Keywords: COVID-19; antimicrobial use; cancer; clinical outcomes; viral shedding.
. 2021 Apr 16;8(6)
fab193.doi: 10.1093/ofid/ofab193. eCollection 2021 Jun.
Clinical and Virologic Characteristics and Outcomes of Coronavirus Disease 2019 at a Cancer Center
Leah H Yoke[SUP] 1 2 [/SUP], Juhye M Lee[SUP] 1 [/SUP], Elizabeth M Krantz[SUP] 1 [/SUP], Jessica Morris[SUP] 1 [/SUP], Sara Marquis[SUP] 1 [/SUP], Pooja Bhattacharyya[SUP] 1 2 [/SUP], Lisa So[SUP] 1 2 [/SUP], Francis X Riedo[SUP] 3 [/SUP], Jason Simmons[SUP] 2 4 [/SUP], Ali Raza Khaki[SUP] 5 6 7 [/SUP], Guang-Shing Cheng[SUP] 5 8 [/SUP], Alexander L Greninger[SUP] 1 9 [/SUP], Steven A Pergam[SUP] 1 2 [/SUP], Alpana Waghmare[SUP] 1 10 11 [/SUP], Chikara Ogimi[SUP] 1 10 11 [/SUP], Catherine Liu[SUP] 1 2 [/SUP]
Affiliations
- PMID: 34183982
- PMCID: PMC8083314
- DOI: 10.1093/ofid/ofab193
Abstract
Background: High morbidity and mortality have been observed in patients with cancer and coronavirus disease 2019 (COVID-19); however, there are limited data on antimicrobial use, coinfections, and viral shedding.
Methods: We conducted a retrospective cohort study of adult patients at the Seattle Cancer Care Alliance diagnosed with COVID-19 between February 28, 2020 and June 15, 2020 to characterize antimicrobial use, coinfections, viral shedding, and outcomes within 30 days after diagnosis. Cycle threshold values were used as a proxy for viral load. We determined viral clearance, defined as 2 consecutive negative results using severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction results through July 30, 2020.
Results: Seventy-one patients were included with a median age of 61 years; 59% had a solid tumor. Only 3 patients had documented respiratory bacterial coinfection. Empiric antibiotics for pneumonia were prescribed more frequently early in the study period (February 29-March 28, 2020; 12/34) compared to the later period (March 29-June 15, 2020; 2/36) (P = .002). The median number of days from symptom onset to viral clearance was 37 days with viral load rapidly declining in the first 7-10 days after symptom onset. Within 30 days of diagnosis, 29 (41%) patients were hospitalized and 12 (17%) died. Each additional comorbidity was associated with 45% lower odds of days alive and out of hospital in the month following diagnosis in adjusted models.
Conclusions: Patients at a cancer center, particularly those with multiple comorbidities, are at increased risk of poor outcomes from COVID-19. Prolonged viral shedding is frequently observed among cancer patients, and its implications on transmission and treatment strategies warrant further study.
Keywords: COVID-19; antimicrobial use; cancer; clinical outcomes; viral shedding.