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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The aim of this study was to determine the risk factors for poor outcomes in intubated, critically ill patients with COVID-19 with multi-drug-resistant pathogens associated secondary bacterial pneumonia. METHODS: This study was restrospective, observational study of 109 crtitcally ill intubated patients with COVID-19 at the intensive care unit(ICU) university hospital from 01 of July to 30 December 2021. RESULTS: In 53 of 109 intubated patients (48.0%) have identified the secondary bacterial infection after 48 hours of intubation and common risk factors associated with invasive mechanical ventilation in patients were:age(p<0.001);lack of use of high nasal cannula(p<0.004);high level of D-dimer(p<0.002);lymphopenia(p<0.001);and low albumin level (p<0.003).Multi-drug-resistant (MDR)pathogens were identified in 37 of 53 patients with ventilator-associated pneumonia(71.0%). In patients with VAP mixed ground glasses/consolidative radiological pattern was common compared to intubated but non-VAP patients(p<0.001).However, in patients with MDR pathogen associated VAP local lung complications such as pleural effusions and lung destructions were commonest compared to non-MDR pathogen associated VAP(p<0.001 and <0.0001;respectively).Among MDR pathogens commonest were:Acinotebacter baumanii(37.0%);Pseudomonas aeruginosa(29.0%) and MRSA(18.0%).MDR pathogen related to VAP in patients was associated with more high median SOFA score (p<0.001) and severe sepsis and septic shock was higher compared to non-MDR VAP patients( OR 4.67 [0.98-8.94]95%CI;p<0.01) and patients with MDR VAP were more resistant to the ventilatory support and their median PaO2/FiO2 was 132(89-194) which was significantly lower compared to non-MDR VAP patients(171[120-254];p<0.001).Serum lactete level, serun creatinine level(acute kidney failure), and serum D-dimer level were significantly higher compared to non-MDR VAP patients(p<0.001 for all three data respectively).Overall mortality rate among intubated patients was 58.0%(64 of 109), however, secondary bacterial infection was associated with higher mortality rate compared to non-VAP patients(73.0% vs 44.0%;p<0.05).MDR pathogen related to VAP patients were characterized with higher in -hopspital mortality compared to non-MDR pathogen related to VAP patients(81.0%vs 52.0%;p<0.05) CONCLUSIONS: Intubated and critically ill patients with COVID-19 are at high risk for development of ventilator -associated pneumonia and commonly such pneumonias are associated with MDR pathogens.Secondary MDR pathogen associated infection in intubated patients commonly is associated with severe sepsis and septick shock, kidney failure and among local lung complications with pleural effusions and lung destructions.MDR pathogents in such patients associated with increased risk of in-hospital mortality. CLINICAL IMPLICATIONS: Critical care physicians, respiratory therapist, nurses, pulmonologists, intensivist DISCLOSURES: no disclosure on file for Pari Khoshbanyani;No relevant relationships by Alizaman Sadigov, source=Web Response no disclosure on file for Bayram Tagiyev;