Acinetobacter baumannii Nosocomial Meningitis Secondary to Neurosurgical Intervention: A Case Report

Nosocomial meningitis is a serious complication of neurosurgical procedures, associated with high morbidity and mortality, as well as significant diagnostic and therapeutic challenges. Among the causative pathogens, Acinetobacter baumannii (A. baumannii) is particularly concerning due to its ability to survive for prolonged periods in the hospital environment, its opportunistic virulence, and, especially, its tendency to develop multidrug resistance to antimicrobial agents. Diagnosis is often difficult in the postoperative setting, particularly when the cerebrospinal fluid (CSF) is altered as a result of the surgical procedure. Rapid identification of the causative agent and early initiation of appropriate antibiotic therapy are essential to limit complications and improve patient prognosis. We report the case of a 27-year-old patient with a history of surgically treated craniopharyngioma complicated by anterior hypopituitarism. Three weeks after surgery, he was admitted to the ICU with suspected postoperative meningitis due to the onset of behavioral disturbances associated with nasal discharge, without a fever. Brain CT was normal. CSF analysis, obtained by lumbar puncture under strict aseptic conditions, revealed a turbid fluid with leukocytosis of 5,760 cells/mm³, predominantly composed of neutrophils, along with elevated protein levels (5.7 g/L) and low glucose levels (0.05 g/L). Direct examination after Gram staining showed Gram-negative coccobacilli with a marked inflammatory reaction. CSF culture grew a multidrug-resistant (MDR) strain of A. baumannii, which was sensitive only to colistin. The patient received antibiotic therapy with colistin, administered intravenously and intrathecally for 18 days, with initial neurological improvement and sterilization of the CSF by the 15th day of treatment. The subsequent course was unfavorable, marked by the development of acute respiratory distress syndrome (ARDS) secondary to ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA), complicated by refractory septic shock, which ultimately led to his death after one month of hospitalization in the ICU. This report highlights the severity of nosocomial meningitis caused by MDR A. baumannii and underscores the importance of implementing infection prevention measures in healthcare settings.