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

<i>Acinetobacter baumannii</i> 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 <i>A. baumannii</i> (CR<i>Ab</i>) 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-CR<i>Ab</i> 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.