# New Delhi Metallo-Beta-Lactamases (NDM)-Carbapenem-Resistant Acinetobacter baumannii Pneumonia: A Case Report

## TL;DR

This case report describes a rare infection caused by NDM-CRAb pneumonia in a 75-year-old man and the treatment challenges faced.

## Contribution

The paper presents a clinical case of NDM-CRAb pneumonia with treatment using polymyxin B and minocycline in the absence of standard therapies.

## Key findings

- The patient improved clinically after two courses of polymyxin B and minocycline.
- The patient required hemodialysis due to acute renal failure caused by the treatment.
- NDM-CRAb infections are rare in the US but are increasing in frequency.

## Abstract

Acinetobacter baumannii are Gram-negative aerobic bacteria, that are ubiquitous in the environment. They are difficult to treat given their numerous intrinsic resistance and ability to acquire resistance genes. Infections caused by carbapenem-resistant A. baumannii (CRAb) with New Delhi Metallo-beta-lactamases (NDM) are rare in the US but have risen in the past few years. There are limited treatment options available. We present a case of NDM-CRAb pneumonia in a 75-year-old man with a history of penicillin anaphylaxis with severe hypoxia requiring intubation and vasopressor support. In the absence of cefiderocol at the medical facility and the inability to use high-dose ampicillin-sulbactam infusion, a combination of polymyxin B and minocycline was used. Two courses of the combination antibiotic therapy were given, initially four days course then another course of 10 days. After this, he improved clinically and was able to be weaned off the ventilator and vasopressors. However, he experienced acute renal failure from polymyxin B and vancomycin, requiring hemodialysis for four months.