Pseudomonas aeruginosa meningitis following autologous hematopoietic stem cell transplantation

Background CNS infections caused by XDR Pseudomonas aeruginosa are life-threatening post-HSCT complications. The emergence of VIM-producing strains severely limits therapeutic options. Case presentation A 70-year-old male developed sepsis due to VIM-producing P. aeruginosa and subsequent meningitis on day + 7 post-autologous HSCT. Despite cefiderocol, meningitis was microbiologically confirmed. Therapy was optimized using 3-hour cefiderocol infusions plus intravenous and intrathecal colistin. The course was complicated by severe neurological decline and secondary thrombotic microangiopathy. Following intensive treatment, CSF sterilization was achieved. The patient ultimately recovered and was discharged with mild residual cognitive impairment. Conclusion This case highlights the efficacy of cefiderocol and dual-route colistin in treating XDR Gram-negative meningitis.