Recurrent External Ventricular Drain–Associated Ventriculitis due to Multidrug-Resistant Acinetobacter baumannii in 2 Siblings

External ventricular drainage (EVD) is a common neurosurgical intervention in pediatric patients but carries a significant risk of ventriculitis, especially during prolonged catheterization and in the presence of multidrug-resistant (MDR) pathogens. We report 2 pediatric siblings who developed prolonged EVD-associated ventriculitis caused by MDR Acinetobacter baumannii during overlapping hospitalizations for different neurological conditions. Both patients required multiple catheter revisions and combined systemic and intrathecal antibiotic therapy because systemic treatment alone was not enough. One sibling was found to have low antibody levels (hypogammaglobulinemia) and needed immunoglobulin replacement, whereas the other had a normal immune workup. These cases highlight the complex relationship between device-related risks, antibiotic resistance, and the patient’s own immune defenses. Individualized, team-based decision-making, early consideration of intrathecal therapy, and thorough immune testing are all key to managing these difficult infections in critically ill children.