Mixed infection with Burkholderia cepacia and Cutibacterium acnes following subarachnoid hemorrhage surgery: a case report.

Intracranial mixed infection represents a rare and critical clinical scenario associated with high mortality and multi-organ failure, and its management remains extremely challenging. We report a 56-year-old female with chronic hepatitis B and intracranial hemorrhage, who developed a severe mixed infection with Burkholderia cepacia (Burkholderia cepacia) and Cutibacterium acnes (C. acnes). Notably, B. cepacia was isolated from blood and sputum specimens, whereas C. acnes was detected in cerebrospinal fluid. The patient experienced progressive systemic deterioration with high fever and multiple organ dysfunction. Multidisciplinary supportive care and targeted antimicrobial strategy achieved effective infection control and gradual recovery of hepatic and renal function. Nevertheless, irreversible neurological damage resulted in persistent coma, and the patient was discharged for palliative care 3 months later. This case highlights the therapeutic difficulties of severe mixed infections with intracranial involvement and provides clinical experience for the management of similar complex critical illnesses.