Structured clinical adjudication of Streptomyces spp. recovered from bronchoalveolar lavage in severe COVID-19 ARDS complicated by polymicrobial lower respiratory tract infection during invasive mechanical ventilation: a case report
Abstract
Background: Lower respiratory tract infections developing during invasive mechanical ventilation in patients with severe COVID-19 acute respiratory distress syndrome (ARDS) present important diagnostic and therapeutic challenges. Streptomyces spp., an uncommon respiratory isolate, frequently raises uncertainty regarding contamination, colonization, or clinically relevant infection because standardized criteria for clinical interpretation are lacking.
Case presentation: A 65-year-old woman with hypertension and obesity was admitted with severe COVID-19 ARDS requiring invasive mechanical ventilation after failure of high-flow nasal cannula. Baseline laboratory evaluation demonstrated leukocytosis (15.65 × 103/μL), neutrophilia (14.73 × 103/μL), lymphopenia (0.92 × 103/μL; neutrophil-to-lymphocyte ratio 16), C-reactive protein 134 mg/L, ferritin 2,130 ng/mL, and procalcitonin 0.5 ng/mL. Bronchoscopy performed approximately 24-36 h after intubation revealed purulent secretions, and quantitative bronchoalveolar lavage culture recovered methicillin-resistant Staphylococcus aureus, CTX-M-positive Klebsiella pneumoniae, and Streptomyces spp. The BioFire FilmArray® Pneumonia Panel confirmed MRSA and K. pneumoniae with CTX-M detection but does not include Streptomyces spp. A structured clinical adjudication process integrating specimen quality, microbiological findings, quantitative culture, host characteristics, radiological assessment, therapeutic context, and clinical evolution…
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