Septic Arthritis Caused by Carbapenem-Resistant Acinetobacter Baumannii with Paradoxical Minocycline Sensitivity: A Case Report.

Multidrug-resistant (MDR) organisms are emerging as an important cause for septic arthritis and one of the major projected reasons for global mortality. Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most challenging bacteria due to limited and often toxic treatment options, and with documented infection-related mortality up to 70% in some settings, as compared to an approximate 25% for susceptible isolates. We describe a rare case of septic arthritis from Northern India due to a CRAB isolate that was resistant to nearly all routine and last-line antibiotics. However, paradoxically, it remained susceptible only to minocycline. The case was treated by minocycline therapy along with surgical management, resulting in a marked clinical improvement and recovery of functional joint mobility on follow-up. This case report draws attention to new challenges faced by physicians in the management of septic arthritis with increasing carbapenem resistance, particularly in low- and middle-income settings. It supports the relevance of "older" antibiotics such as minocycline, when guided by a culture and sensitivity-based approach, and underlines the importance of strict antimicrobial stewardship to counteract the rising antimicrobial resistance (AMR) challenge.