Efficacy of intraventricular amikacin treatment in pan-resistant Pseudomonas aeruginosa postsurgical meningitis Mariadelfina Molinaro,1 Paola Morelli,2 Manuela De Gregori,1,3,4 Simona De Gregori,1 Ilaria Giardini,1 Federica Tordato,2 Vincenzina Monzillo,5,6 Daria Pocaterra,2 Erminia Casari7 1Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 2Infectious Diseases Unit, Hospital Health Direction, Humanitas Clinical and Research Center, Milan, 3Pain Therapy Service, Fondazione IRCCS Policlinico San Matteo, Pavia, 4Study in Multidisciplinary Pain Research Group, Parma, 5Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 6Infectious Diseases Unit, Internal Medicine and Medical Therapy Department, University of Pavia, Pavia, 7Microbiology Unit, Analysis Laboratory, Humanitas Clinical and Research Center, Milan, Italy Background: We describe a case of pan-resistant Pseudomonas aeruginosa postsurgical meningitis associated with the presence of an external ventricular device. We changed therapy twice; finally, by using amikacin and a continuous infusion of cefepime, we obtained clinical improvement. Case presentation: A female patient, who underwent surgery for a cavernous angioma, presented with meningitis. Cerebrospinal fluid culture revealed a multidrug-resistant Pseudomonas aeruginosa, initially sensitive only to colistin. We successfully used intrathecal amikacin and intravenous cefepime continuous infusion plus intravenous amikacin after two previous ineffective therapeutic approaches. Conclusion: The evaluation of the antibiotic concentration and the bactericidal activity in cerebrospinal fluid may contribute to the choice of the drug in cases of multidrug-resistant meningitis. Keywords: pan-resistant meningitis, Pseudomonas aeruginosa, amikacin