Zhaolu Meng,1 Rehanguli Wuxiuer,1 Feng Zhao,2 Qiao Yang1,3 

1Department of Infectious Diseases, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer, 843300, People’s Republic of China; 2Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Alaer Hospital, Zhejiang University School of Medicine, Alaer, 843300, People’s Republic of China; 3Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China

Correspondence: Qiao Yang, Email zjuyangqiao@zju.edu.cn

Background: The co-infection of COVID-19 with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is rare but can lead to severe outcomes, especially in diabetic patients with impaired immune function. CA-MRSA, especially PVL-positive strains, can exacerbate COVID-19 symptoms and drive rapid disease progression.
Patient and Methods: We present a case of a 53-year-old diabetic female patient with poor glycemic control, who was hospitalized with COVID-19 and rapidly progressed to severe pneumonia. Despite antiviral treatment with Paxlovid and dexamethasone, as well as antimicrobial therapy with piperacillin-tazobactam, her condition deteriorated, leading to respiratory failure requiring extracorporeal membrane oxygenation. A post-mortem sputum culture confirmed MRSA on the day following the patient’s death.
Conclusion: This case underscores the critical need for screening and treating bacterial co-infections in COVID-19 management, particularly in immunocompromised hosts, due to the enhanced pathogenicity of CA-MRSA strains. Early recognition and appropriate antimicrobial therapy are essential in reducing the impact of such co-infections.

Keywords: COVID-19, methicillin-resistant Staphylococcus aureus, co-infection, diabetes mellitus, pneumonia