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Background: Despite multiple reports of increased incidence of bacterial respiratory tract infections following COVID-19 globally, the microbiology is not yet fully elucidated. In this study, we describe the microbiology of bacterial infections and the prevalence of multidrug resistant organisms (MDROs) in hospitalized COVID-19 patients with community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP) which includes both non-ventilated hospital acquired pneumonia (NVHAP) and ventilator-associated pneumonia (VAP). To our knowledge, this is the first study that compares the microbiology of VAP and NVHAP in COVID-19 patients. Methods: This is a longitudinal retrospective cohort study conducted at the American University of Beirut Medical Center (AUBMC), a tertiary-care centre in Lebanon. Adult patients with confirmed COVID-19 and concurrent bacterial respiratory infections with an identifiable causative organism who were hospitalized between March 2020 and September 2021 were included. Bacterial isolates identified in hospital-acquired pneumonia (HAP) were divided into 3 groups based on the time of acquisition of pneumonia after admission: hospital day 3–14, 15–28 and 29–42. Results: Out of 1674 patients admitted with COVID-19, 159 (9.5%) developed one or more respiratory infections with an identifiable causative organism. Overall, Gram-negative bacteria were predominant (84%) and Stenotrophomonas maltophilia was the most common pathogen, particularly in HAP. Among 231 obtained isolates, 59 (26%) were MDROs, seen in higher proportion in HAP, especially among patients with prolonged hospital stay (> 4 weeks). Non-fermenter Gram-negative bacilli (NFGNB) (OR = 3.52, p-value

Interstitial lung disease (ILD) exacerbation is a serious condition that can have a high morbidity and mortality. Identifying the triggers of ILD exacerbations is very challenging. Several case reports described COVID-19 vaccine-induced exacerbation of underlying interstitial lung disease, namely idiopathic interstitial pneumonias. The clinical implications of this adverse effect is underrecognized. We are reporting a case of fatal respiratory failure in a patient with rheumatoid arthritis Interstitial Lung disease few days following the second dose of COVID vaccine. Identifying risk factors of this complication is of utmost importance to aid in the rapid recognition and early initiation of treatment.

Conclusion: CDT with tenecteplase was, for the first time, safely and effectively used in an intermediate high-risk PE patient. However, more studies are needed to confirm and establish these findings.