Catheter-Associated Vancomycin-Resistant Enterococcus faecium Ventriculitis and Multidrug-Resistant Acinetobacter baumannii Pneumonia With Subsequent Acinetobacter Ventriculitis: A Case Report.

Ventriculitis is associated with cerebrospinal fluid (CSF) shunts, and rare microorganisms associated with infection include vancomycin-resistant (VRE) and . Both organisms are known to cause nosocomial infections, and the emergence of multidrug-resistant (MDR) strains presents a treatment challenge. There is a lack of consensus on antimicrobial agent selection for ventriculitis involving VRE or MDR , which are life-threatening conditions. We present a case of a 59-year-old male presenting with CSF catheter-associated VRE ventriculitis and MDR pneumonia who subsequently developed a nosocomial MDR ventriculitis. Both instances of ventriculitis were successfully treated with combination antibiotic therapy. VRE ventriculitis was successfully treated with linezolid and intrathecal daptomycin. While daptomycin is not approved for infections, the synergistic effect of daptomycin in combination with linezolid proved effective. Although the MDR pneumonia was not cured with cefiderocol monotherapy, the MDR ventriculitis was successfully treated with combination therapy including cefiderocol, ampicillin/sulbactam, and intrathecal colistin. This highlights life-saving combination antibiotic therapies for ventriculitis caused by multiple rare and drug-resistant microorganisms.