Aztreonam plus ceftazidime-avibactam for post-neurosurgical meningitis due to Stenotrophomonas maltophilia

Clinical evidence is lacking regarding the efficacy of aztreonam-avibactam in severe infections involving Stenotrophomonas maltophilia. We report a case of post-neurosurgical meningitis due to S. maltophilia (minimal inhibitory concentration of aztreonam plus avibactam, 4/4 µg/mL) clinically and microbiologically cured with a combination of aztreonam and ceftazidime-avibactam (2 g and 2 g/500 mg q8h, 3 h simultaneous infusions). Therapeutic drug monitoring showed adequate concentrations of aztreonam and avibactam in the cerebrospinal fluid at each time point over the 14-day treatment duration.