Recurrence of Postneurosurgical Central Nervous System Infection Caused by Acinetobacter baumannii in a Critically Ill Patient Treated With Cefiderocol. A Case Report

Introduction Acinetobacter baumannii ( A. baumannii ), a gram‐negative bacterium, has become a significant hospital pathogen and the cause of severe nosocomial infections, especially in the intensive care unit (ICU). Bacterial meningitis is a recognized complication that can occur after neurosurgery, and the number of cases of multidrug‐resistant (MDR) meningitis caused by A. baumannii is increasing. Critically ill patients in the ICU are at high risk, and the consequences are potentially fatal. Cefiderocol is a novel cephalosporin that can treat carbapenem‐resistant infections in patients with limited treatment options. No clinical trials have investigated its capability to penetrate cerebrospinal fluid. Case Presentation We describe the case of a 66‐year‐old man who was admitted to our neurointensive care unit after head trauma. On the CT scan performed on admission to the hospital, there was evidence of a subdural hematoma and subarachnoid and intraparenchymal hemorrhages in the frontotemporal region bilaterally. The patient then underwent a decompressive craniectomy. During hospitalization and following cranioplasty, the patient experienced a central nervous recurrence of carbapenem‐resistant A. baumannii (CRAB) meningitis, which was treated with cefiderocol, resulting in a resolution of signs and symptoms of infection within a few days. Conclusion We present the first case of CRAB meningitis treated with this cefiderocol dosing regimen. In our case of postneurosurgical MDR meningitis reinfection caused by A. baumannii , cefiderocol as monotherapy brought about a clinical and microbiological cure in both blood and cerebrospinal fluid without the occurrence of adverse effects such as seizure.