First reported mortality from XDR Acinetobacter Baumannii Meningitis following posterior lumbar interbody fusion in Iran: a case report

BACKGROUND: Bacterial meningitis is a rare but serious complication following neurosurgical procedures. Acinetobacter baumannii (A. baumannii) has emerged as an opportunistic pathogen, causing serious infections worldwide. The increasing prevalence of multidrug-resistant strains presents growing challenge in healthcare settings. The occurrence of multidrug-resistant A. baumannii meningitis after Posterior Lumbar Interbody Fusion (PLIF) surgery is exceptionally uncommon. CASE PRESENTATION: We report a 59-year-old osteoporotic female who developed A. baumannii meningitis resistant to our available antibiotics following PLIF for L5/S1 spondylolisthesis. Although a minor durotomy occurred during surgery due to sever adhesion in the inflamed tissue and no cerebrospinal fluid (CSF) leakage was observed postoperatively. The patient experienced fever and headache on first day after discharge which was managed with ondansetron, and then gradual loss of consciousness six days after discharge occurred, leading to her readmission. Despite administration of intravenous antibiotics and two courses of intrathecal antibiotic therapy via an External Ventricular Drain (EVD), her condition progressively deteriorated, and she ultimately succumbed to the infection. CONCLUSION: This case highlights the critical importance of maintaining dura integrity and adhering to strict operating room sterilization protocols. As resistant organisms become increasingly prevalent, healthcare providers must exercise heightened vigilance in the early recognition and management of infections following neurosurgical procedures.