Abstract
RATIONALE: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia is a severe and rapidly progressing infection that can lead to acute respiratory distress syndrome and septic shock. The use of venovenous extracorporeal membrane oxygenation (ECMO) may improve outcomes in critically ill patients who fail conventional mechanical ventilation. PATIENT CONCERNS: Two female patients, aged 14 and 32 years, presented with fever and cough before hospital admission. Both patients rapidly developed severe respiratory distress and hemodynamic instability, raising concerns for a life-threatening infection. DIAGNOSES: Both patients were diagnosed with severe pneumonia caused by CA-MRSA, complicated by acute respiratory distress syndrome and septic shock. Microbiological testing confirmed the presence of CA-MRSA in respiratory samples. INTERVENTIONS: The patients were initially treated with broad-spectrum anti-infective agents, including linezolid, targeting CA-MRSA. Due to the failure of conventional mechanical ventilation to maintain adequate oxygenation, venovenous ECMO was initiated to support respiratory function. The patients also received hemodynamic support and other adjunctive therapies for septic shock. OUTCOMES: Following the initiation of ECMO and targeted antibiotic therapy, both patients showed significant clinical improvement. Lung function recovered well, and they were successfully weaned off ECMO and mechanical ventilation. Both patients were eventually discharged with favorable outcomes. LESSONS: CA-MRSA pneumonia can progress rapidly to severe respiratory failure and septic shock, necessitating aggressive interventions. Venovenous ECMO, combined with timely and appropriate antibiotic therapy can be life-saving in such cases. This report highlights the importance of early recognition, multidisciplinary management, and the potential benefits of ECMO in severe CA-MRSA pneumonia. It serves as a clinical reference for the treatment of similar cases.