{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:18:05Z","timestamp":1787811485146,"version":"build-2784847793"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      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.\n                      <jats:italic>Streptomyces<\/jats:italic>\n                      spp., an uncommon respiratory isolate, frequently raises uncertainty regarding contamination, colonization, or clinically relevant infection because standardized criteria for clinical interpretation are lacking.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      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 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      \/\u03bcL), neutrophilia (14.73 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      \/\u03bcL), lymphopenia (0.92 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      \/\u03bcL; 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\u201336 h after intubation revealed purulent secretions, and quantitative bronchoalveolar lavage culture recovered methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      , CTX-M\u2013positive\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      , and\n                      <jats:italic>Streptomyces<\/jats:italic>\n                      spp. The BioFire FilmArray\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Pneumonia Panel confirmed MRSA and\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      with CTX-M detection but does not include\n                      <jats:italic>Streptomyces<\/jats:italic>\n                      spp. A structured clinical adjudication process integrating specimen quality, microbiological findings, quantitative culture, host characteristics, radiological assessment, therapeutic context, and clinical evolution supported interpretation of\n                      <jats:italic>Streptomyces<\/jats:italic>\n                      spp. as most compatible with colonization rather than invasive pulmonary infection. Antimicrobial therapy was optimized with meropenem and linezolid according to the confirmed bacterial pathogens, without additional organism-specific therapy directed against\n                      <jats:italic>Streptomyces<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates the application of a structured clinical adjudication process to interpret recovery of an uncommon respiratory microorganism under conditions of microbiological uncertainty. Integration of quantitative bronchoalveolar lavage culture, rapid multiplex PCR, host factors, radiological assessment, and clinical evolution may support antimicrobial optimization while avoiding overinterpretation of uncommon respiratory isolates. The proposed approach should be regarded as an educational and descriptive clinical illustration requiring evaluation in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1880981","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:33:40Z","timestamp":1787808820000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Killen H.","family":"Briones-Claudett","sequence":"first","affiliation":[{"name":"Universidad de Especialidades Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"]},{"name":"Briones PulmoCare, Medical Education and Research Group","place":["Guayaquil, Ecuador"]},{"name":"Universidad de Guayaquil","place":["Guayaquil, Ecuador"]},{"name":"Omni Hospital","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime Benites","family":"Sol\u00eds","sequence":"additional","affiliation":[{"name":"Omni Hospital","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Fernanda Pico","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Briones PulmoCare, Medical Education and Research Group","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Barberan-Torres","sequence":"additional","affiliation":[{"name":"Universidad Internacional del Ecuador (UIDE)","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana C. Briones","family":"M\u00e1rquez","sequence":"additional","affiliation":[{"name":"Briones PulmoCare, Medical Education and Research Group","place":["Guayaquil, Ecuador"]},{"name":"Omni Hospital","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Parreno","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednica Panamericana","place":["Guayaquil, Ecuador"]},{"name":"Interhospital S.A.","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivonne","family":"Asqui","sequence":"additional","affiliation":[{"name":"Instituto Ecuatoriano de Seguridad Social (IESS)","place":["Guayaquil, Ecuador"]},{"name":"Instituto Universitario Italiano de Rosario (IUNIR)","place":["Rosario, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anah\u00ed D.","family":"Briones-Zamora","sequence":"additional","affiliation":[{"name":"Universidad de Especialidades Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"]},{"name":"Briones PulmoCare, Medical Education and Research Group","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Killen H.","family":"Briones-Zamora","sequence":"additional","affiliation":[{"name":"Universidad de Especialidades Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6201","DOI":"10.3390\/jcm13206201","article-title":"Secondary bacterial infections in critically Ill COVID-19 patients admitted in the intensive care unit of a tertiary hospital in Romania.","volume":"13","author":"Pintea-Simon","year":"2024","journal-title":"J Clin Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"210","DOI":"10.4103\/lungindia.lungindia_293_22","article-title":"Secondary infections in critically ill patients with COVID-19: a retrospective single-center study.","volume":"40","author":"Haque","year":"2023","journal-title":"Lung India"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1177\/08850666211021745","article-title":"Characterization of secondary bacterial infections and antibiotic use in mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome.","volume":"36","author":"Risa","year":"2021","journal-title":"J Intensive Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1309\/QJEBXP0BCGR54L15","article-title":"Invasive Streptomyces infections: six cases and literature review.","volume":"127","author":"Kapadia","year":"2007","journal-title":"Am J Clin Pathol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"ofac271","DOI":"10.1093\/ofid\/ofac271","article-title":"Identification of Streptomyces spp. in a clinical sample: always contamination? 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