Abstract：
We report a Russian case of a 61-year-old male patient with confirmed COVID-19 infection who developed nosocomial pneumonia complicated by lung abscess associated with multi-drug-resistant isolates of Klebsiella pneumoniae and Acinetobacter baumannii, which could have been provoked due to the immunosuppressive therapy. We discuss the existing literature highlighting the issue of the prudent balance between benefits and risks when prescribing immunomodulators to hospitalized patients with COVID-19 due to the risk of difficult-to-treat nosocomial infections caused by MDR Gram-negative bacterial pathogens. Currently, there is evidence of a substantial positive effect of dexamethasone on the course of COVID-19 in patients requiring supplemental oxygen or anti-interleukin-6 drugs in individuals with prominent systemic inflammation. However, it seems that in real clinical practice, the proposed criteria for initiating treatment with immunomodulators are interpreted arbitrarily, and the doses of dexamethasone can significantly exceed those recommended.
摘要：
我们报告了一例俄罗斯61岁男性患者，确诊为COVID-19感染，该患者发生医院获得性肺炎并发肺脓肿，并与肺炎克雷伯菌和鲍曼不动杆菌的多重耐药菌株相关，这可能是由于免疫抑制疗法引起的。我们讨论了现有文献，这些文献强调了在为COVID-19住院患者开具免疫调节剂时，由于MDR革兰氏阴性细菌病原体引起的难以治疗的医院感染的风险，因此在收益和风险之间谨慎平衡的问题。目前,有证据表明,在需要补充氧气或抗白细胞介素6药物的患者中,地塞米松对COVID-19的病程有显著的积极作用。然而,在真正的临床实践中，用免疫调节剂开始治疗的拟议标准是任意解释的，地塞米松的剂量可以显著超过推荐剂量。
