Post-acute COVID-19 associated with evidence of bystander T-cell activation and a recurring antibiotic-resistant bacterial pneumonia.

Here we describe the case of a COVID-19 patient who developed recurring ventilator23 associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels 24 of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed 25 the AMR genotype, while immunological analysis revealed massive and escalating levels of 26 T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander 27 activated, which may have contributed to this patient’s persistent symptoms and radiological 28 changes.