Abstract
Continuous positive airway pressure (CPAP) therapy is commonly prescribed for obstructive sleep apnea. However, improper cleaning and maintenance of CPAP equipment can create an environment that encourages bacterial colonization, leading to opportunistic respiratory infections in patients, especially in immunocompromised patients with concomitant comorbidities such as chronic obstructive pulmonary disease (COPD). We describe the case of a 57-year-old male patient with a history of chronic bronchitis, bronchiectasis, COPD, and obstructive sleep apnea who presented to the emergency department with worsening dyspnea, productive cough, and respiratory distress. Imaging revealed pneumonia and a respiratory pathogen panel identified Pseudomonas aeruginosa along with Moraxella and Proteus species. The patient admitted to poor CPAP maintenance and noted green-colored growth on his mask, consistent with Pseudomonas colonization. His symptoms improved with tailored antibiotic therapy. CPAP equipment requires routine cleaning to prevent bacterial growth. P. aeruginosa, a waterborne pathogen that thrives in humid environments, can colonize improperly maintained equipment, leading to severe respiratory infections, especially in immunocompromised patients. This case highlights the need for patient education on CPAP hygiene to prevent infectious complications. Further research is needed to clarify the relationship between CPAP use, water quality, and infection risk, thereby informing evidence-based guidelines for both clinicians and patients.