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Sir, Cefiderocol is a new siderophore cephalosporin, with potent activity against MDR Gram-negative bacilli. It is particularly active against XDR Acinetobacter baumannii (Ab) infections, for which treatment options are quite limited. 1–3 Herein, we describe a case of an adult male patient with severe H1N1 influenza complicated by ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) caused by XDR Ab and carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). Nothing remarkable was in his medical history apart from favism and Aarskog–Scott syndrome. In February 2019, due to the onset of acute respiratory failure, he was admitted to a peripheral primary ICU where he was diagnosed with H1N1 influenza virus complicated by bilateral pneumonia. The patient was immediately intubated and then transferred to our hospital where extracorporeal membrane oxygenation (ECMO) was started …