Nosocomial Outbreak of COVID-19 from a Kidney Transplant Patient: Necessity of a Longer Isolation Period in Immunocompromised Patients

Chang Seong Kim; Uh Jin Kim; Yoonjung Lee; Unhee Lee; Okja Choi; Sun-Hee Kim; Kwangho Lee; Yoon-Seok Chung; Hong Sang Choi; Eun Hui Bae; Seong Kwon Ma; Seong Eun Kim; Seung-Ji Kang; Sook-In Jung; Soo Wan Kim; Kyung-Hwa Park

doi:10.3947/ic.2022.0124

Nosocomial Outbreak of COVID-19 from a Kidney Transplant Patient: Necessity of a Longer Isolation Period in Immunocompromised Patients

Infect Chemother. 2023 Mar;55(1):42-49. doi: 10.3947/ic.2022.0124. Epub 2022 Nov 18.

Authors

Chang Seong Kim^#^{1

2}, Uh Jin Kim^#^{2

3}, Yoonjung Lee^#³, Unhee Lee⁴, Okja Choi⁴, Sun-Hee Kim⁵, Kwangho Lee⁶, Yoon-Seok Chung⁷, Hong Sang Choi^{1

2}, Eun Hui Bae^{1

2}, Seong Kwon Ma^{1

2}, Seong Eun Kim^{2

3}, Seung-Ji Kang^{2

3}, Sook-In Jung^{2

3}, Soo Wan Kim^#^{1

8}, Kyung-Hwa Park^#^{2

3

9}

Affiliations

¹ Department of Nephrology, Chonnam National University Hospital, Gwangju, Korea.
² Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
³ Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Korea.
⁴ Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Korea.
⁵ Division of Emerging Infectious Disease, Health and Environmental Research Institute of Gwangju City, Gwangju, Korea.
⁶ Division of Emerging Infectious Disease, Department of Infectious Disease Research, Health and Environment Research Institute of Gwangju, Gwangju, Korea.
⁷ Division of Infectious Disease Diagnosis Control, Honam Regional Center for Disease Control and Prevention, Korea Diseases Control and Prevention Agency, Gwangju, Korea.
⁸ Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. skimw@chonnam.ac.kr.
⁹ Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Korea. iammedkid@naver.com.

^# Contributed equally.

Abstract

Background: Determination of the release from isolation for coronavirus disease 2019 (COVID-19) in immunocompromised patients who need additional hospitalization for treatment of non-COVID-19 related disease is important to prevent nosocomial transmission. However, there is insufficient evidence for an extended isolation period.

Materials and methods: In September 2021, when the Delta variant was dominant, a nosocomial outbreak of COVID-19 occurred in the nephrology ward of a tertiary hospital in Gwangju, Korea. We conducted epidemiological investigations and whole-genome sequencing (WGS) of this virus.

Results: A man who underwent kidney transplantation was admitted to our hospital for the treatment of acute kidney injury. He was diagnosed with asymptomatic COVID-19 infection during a pre-admission screening test on September 1, 2021 and underwent isolation. After 10 days of isolation in the COVID-19-designated ward, he was transferred to the general nephrology ward. He underwent steroid pulse therapy (September 17 to September 23, >60 mg/day prednisolone) due to acute T-cell rejection. On September 28, 2021, the first patient with COVID-19 was identified in the nephrology ward, and a rapid-response team was activated to identify additional patients with COVID-19 and prevent the spread of COVID-19. Epidemiological investigations revealed that 12 patients, two caregivers, and three healthcare workers from the nephrology ward were diagnosed with COVID-19. The WGS of specimens from 14 nosocomial outbreak samples and released an index patient exhibited the same Delta variant originating from the B.1.617.2 lineage. This hospital-acquired COVID-19 outbreak in the nephrology ward resulted in two (11.7%) deaths in patients who underwent kidney transplantation.

Conclusion: We demonstrated that an immunocompromised patient can cause a nosocomial outbreak due to the prolonged shedding of infectious viruses. Prolonged isolation in patients under active immunosuppressive therapy may be necessary to prevent transmission, especially in the hospital setting.

Keywords: COVID-19; Cross infection; Disease outbreaks; Immunocompromised hosts; Isolation.

Abstract

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