Many studies have been conducted on ventilator-associated complications (VACs) in COVID-19 patients. However, in these studies, the causative organisms were similar, and there are no reports on VAC corresponding with Corynebacteria. Coryneforms are frequently cultured in polymicrobial infections and are usually considered contaminants in respiratory specimens. However today, Corynebacterium pseudodiphtheriticum or striatum is known to be a pathogen in lower respiratory tract infection. We report three cases of VAC probably due to Corynebacterium pseudodiphtheriticum in COVID-19 patients. If purulent lower respiratory specimens showed coryneform predominantly via Gram staining, empirical therapy should be started. Furthermore, species identification and drug susceptibility testing should be performed.

Methicillin-resistant Staphylococcus aureus (MRSA) USA300 is a representative communityassociated MRSA (CA-MRSA) clone around the world. We herein report a patient of USA300 clone infection who could not be saved. A 25-year-old man who had sex with men presented with fever lasting one week and skin lesions on the buttocks. Computed tomography imaging showed the findings of multiple nodules and consolidations, especially in the peripheral lung fields, right iliac vein thrombosis, and pyogenic myositis of bilateral medial thighs. Blood cultures revealed MRSA bacteremia. The conditions of the patient deteriorated rapidly, complicated by acute respiratory distress syndrome and infective endocarditis, and was finally intubated on the 6th hospital day and died on the 9th day. Multilocus sequence typing of this patient's MRSA strain was sequence type 8, had a staphylococcal cassette chromosome of mec type IVa, Panton-Valentine leukocidin gene, and the arginine catabolic mobile element, indicating it was USA300 clone. Past literatures suggest that CA-MRSA skin lesions presenting with furuncle or carbuncle on the lower body are at a high risk for severe disease. The patient's background and appearance as well as the location of the skin lesions should be critical for the early diagnosis of severe CA-MRSA infection.

A 73-year-old female was transferred to our hospital with respiratory distress, and suffered a cardiac arrest (CA) after her arrival. We immediately started cardiopulmonary resuscitation (CPR), during which we use a mechanical chest compression device, the AutoPulse ® (Asahi Kasei ZOLL Medical Corporation). We diagnosed the patient with a CA caused by a pulmonary thromboembolism. Although her hemodynamics were well maintained following the return of spontaneous circulation, they suddenly became unstable 15 hours after her admission to the ICU. Then, progressive anemia was detected. Abdominal ultrasonography and CT revealed injuries to the liver and spleen and multiple rib fractures; hence, we diagnosed the patient with hypovolemic shock. We performed splenectomy and coagulative hemostasis for the liver laceration. Conclusion: It was suggested that the shifting of the AutoPulse ® band to the caudal side due to the patient's obesity (BMI 38 kg/m 2), might have caused these complications. When using mechanical chest compression devices, clinicians should be familiar with its characteristics, and must take care to avoid complications.

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