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.
摘要：
2019年严重冠状病毒病(COVID-19)患者面临多重耐药菌(MDRO)继发感染的高风险。继发感染导致COVID-19患者的临床病程更严重，重症监护病房(ICU)住院时间更长。一名60多岁的男子因严重的COVID-19肺炎入院，需要机械通气。由于亚胺培南非易感的产气克雷伯菌引起的持续菌血症，他的呼吸状况进一步恶化，他需要VV-ECMO。随后，由于白色念珠菌，他出现了导管相关性血流感染（CRBSI），多重耐药铜绿假单胞菌（MDRP）引起的呼吸机相关性肺炎（VAP），尽管感染控制程序最大限度地提高了接触预防措施，并且在患者的房间环境中没有MDRO污染，但由于耐碳青霉烯类产气钾引起的肛周脓肿。在总共72天的ECMO支持后，他被从VV-ECMO拔管，并最终在第138天脱离呼吸机支持并从ICU出院。这个案例凸显了预防的挑战，诊断,并在重症COVID-19的重症监护管理中治疗多药耐药菌和医疗保健相关感染（HAIs）。除了严格执行感染预防措施外，此类患者需要高度怀疑和仔细评估HAIs.
