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Acute bacterial meningitis (ABM) is the medical emergency which warrants an early diagnosis and an aggressive therapy. Despite the availability of the potent newer antibiotics, the mortality caused by ABM and its complications remain high in India, ranging from 16% to 32%. The aim of this case report is to present the rare isolation of Pseudomonas putida from cerebrospinal fluid sample. Besides this, the author also emphasizes the importance of correctly identifying the organism and thus the selection of the most accurate antibiotic from the susceptibility profile to allow for early recovery and to improve the patient outcome and survival.

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Genetic variability in the form of micro evolutionary changes such as point mutations or macro evolutionary changes such as changes in the large segment of DNA of the microorganisms could ultimately affect the antimicrobial susceptibility of the organism. Not only acquired antibiotic resistance but intrinsic resistance is also not an exception to the evolution of the organisms for the survival which has been approved and documented by number of the clinical trials and minimum inhibitory concentration (MIC) studies. To prove and review this, in house study about mutants or altered phenotypes recovered from exudates, urine and blood with the uncommon susceptibility pattern was undertaken in my hospital. Final results were informed to the clinicians so as to check the compliance of the majority of the patients to un-recommended antibiotics due to known intrinsic resistance. The present study did help in the management of the patients though the testing of the panel of antibiotics is not advised by CLSI guidelines.