Multiple secondary healthcare-associated infections due to carbapenem-resistant organisms in a critically Ill COVID-19 patient on extensively prolonged venovenous extracorporeal membrane oxygenation support—a case report

Hiroaki Baba, Hajime Kanamori, Issei Seike, Ikumi Niitsuma-Sugaya, Kentaro Takei, Kengo Oshima, Yudai Iwasaki, Yuko Ogata, Hirona Nishimaki, Daisuke Konno, Takuya Shiga, Koji Saito, Koichi Tokuda, Tetsuji Aoyagi

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with severe Coronavirus disease 2019 (COVID-19) are at high risk for secondary infection with multidrug-resistant organisms (MDROs). Secondary infections contribute to a more severe clinical course and longer intensive care unit (ICU) stays in patients with COVID-19. A man in his 60s was admitted to the ICU at a university hospital for severe COVID-19 pneumonia requiring mechanical ventilation. His respiratory condition worsened further due to persistent bacteremia caused by imipenem-non-susceptible Klebsiella aerogenes and he required VV-ECMO. Subsequently, he developed a catheter-related bloodstream infection (CRBSI) due to Candida albicans, ventilator-associated pneumonia (VAP) due to multidrug-resistant Pseudomonas aeruginosa (MDRP), and a perianal abscess due to carbapenem-resistant K. aerogenes despite infection control procedures that maximized contact precautions and the absence of MDRO contamination in the patient’s room environment. He was decannulated from VV-ECMO after a total of 72 days of ECMO support, and was eventually weaned off ventilator support and discharged from the ICU on day 138. This case highlights the challenges of preventing, diagnosing, and treating multidrug-resistant organisms and healthcare-associated infections (HAIs) in the critical care management of severe COVID-19. In addition to the stringent implementation of infection prevention measures, a high index of suspicion and a careful evaluation of HAIs are required in such patients.

Original languageEnglish
Article number19
JournalMicroorganisms
Volume10
Issue number1
DOIs
Publication statusPublished - 2022 Jan
Externally publishedYes

Keywords

  • COVID-19
  • Carbapenem-resistant
  • Case report
  • Extracorporeal membrane oxygenation
  • Healthcare-associated infections
  • Intensive care
  • Multi-resistant pathogens

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)
  • Virology

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