Origin of pan-drug-resistant Acinetobacter baumannii infection in a neonate with gastroschisis: nosocomial or agricultural source? A case report

BACKGROUND: Pan-drug resistance (PDR) in neonatal surgical cases remains rare and poorly understood. The intersection of congenital anomalies with PDR infections poses unique clinical challenges. CASE PRESENTATION: A Javanese male neonate was delivered vaginally at 36 weeks' gestation from a 23-year-old mother. The neonate was diagnosed with gastroschisis, along with a 2.5-cm gastric perforation and an ileal perforation located 7 cm proximal to the ileocecal junction. Emergency surgery was undertaken, consisting of primary gastric perforation repair and a double-barrel ileostomy. The patient developed postoperative sepsis due to PDR Acinetobacter baumannii. Following multidisciplinary consultation, all antibiotics were discontinued; the patient gradually improved clinically, with fever resolution and negative follow-up cultures. CONCLUSION: This case highlights that PDR infections in neonates may not be solely hospital-acquired but may also arise from environmental or agricultural sources. Crucially, it underscores the importance of reinforcing infection control strategies and expanding antimicrobial resistance surveillance to community and agricultural environments to better detect, prevent, and contain emerging resistant strains.