This patient is a 73-year-old male with a past medical history of abdominal aortic aneurysm status post endovascular repair 3 years before presentation, moderate-to-severe aortic stenosis, and coronary artery disease. His hospital course began with a bioprosthetic aortic valve replacement and subsequent double coronary artery bypass. His immediatepostoperative course was complicated by acute hypoxemic respiratory failure, right ventricle failure, and cardiogenic shock requiring inotropes. He was admitted to the cardiovascular ICU and eventually progressed to multisystem organ failure with shock liver, acute kidney injury requiring CRRT, and worsening cardiogenic shock requiring mechanical circulatory support (MCS) with concomitant Impella CP  and ProtekDuo . He was cardioverted after an episode of monomorphic ventricular tachycardia and found to have a pericardial effusion for which he underwent a pericardial window and thoracostomy. An 8-0 cuffed shiley tracheostomy tube was also placed at that time. He had several infectious complications throughout his hospitalization that included Escherichia coli ventilator-associated pneumonia, treated with meropenem and minocycline. A groin wound grew Pseudomonas aeruginosa and was treated again with meropenem. However, after 12 days of meropenem, he developed pancytopenia and hematology was consulted to evaluate for potential causes. His WBC at that time was 1.44 x 103 cells, and his absolute neutrophil count was <100 cells. Disseminated intravascular coagulation secondary to an infection, consumption by MCS devices, as well as medications, notably meropenem and colchicine, were included in the differential. He was switched from meropenem to ciprofloxacin to rule out beta-lactam-induced neutropenia, and daily tbo-filgrastim was started. After starting ciprofloxacin, he developed a diffuse macular rash concerning DRESS (53% eosinophilia). All antibiotics were stopped; however, the patient developed worsening shock and repeat blood cultures grew XDR Citrobacter freundii. He was started on eravacycline and gentamicin and later switched to eravacycline and amikacin. His central line was replaced, and he was maintained on broad-spectrum antibiotics. On HD62, a CT chest showed multifocal infiltrates and sputum cultures grew MDR Providencia rettgeri and MDR Morganella morganii prompting the addition of ceftazidime-avibactam. On HD76, serous drainage from a chest wound grew M. odoratus (Table 1). Eravacycline was continued for M. odoratus coverage, and his remaining antibiotics were escalated to cefiderocol for worsening shock. Two days after sample collection, his Impella CP  was replaced. Repeat blood cultures on HD84 also grew M. odoratus and eravacycline was switched to IV minocycline out of concern for nonsusceptibility. While this patient had several previous gram-negative organisms isolated, the isolation of M. odoratus alone in blood cultures in addition to clinical worsening led to the decision to consider this the causative pathogen. Notably, this isolate from the blood was phenotypically different from the isolate from his chest wound (Table 1). The patient received 16 days of cefiderocol and minocycline; unfortunately the patient continued to deteriorate and ultimately expired.