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The authors describe a case of emergence of multi-resistant pathogens in a cystic fibrosis patient treated with inhaled vancomycin: A ten-year-old female patient, chronically infected with methicillin-resistant Staphylococcus aureus, presenting worsening of lung disease. She was placed on inhaled vancomycin with clinical improvement, but B. cepacia complex was isolated in sputum and vancomycin-resistant Enterococcus faecium was identified in a rectal swab culture during treatment. The authors concluded that the use of inhaled vancomycin must be avoided in cystic fibrosis patients, since it may be related to the appearance of vancomycin-resistant Enterococcus sp., and, therefore, to the increase of the risk of emergence of vancomycin-resistant Staphylococcus aureus.