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Late-onset sepsis (LOS) is commonly associated with pathogens acquired in hospital or community settings and carries a significant risk of morbidity and mortality in neonates. We present a case of a late preterm neonate, born at 36 weeks and 2 days with low birth weight (1700 g), who was admitted to the neonatal intensive care unit (NICU) and developed LOS on the fourth day of life. LOS was diagnosed in the context of fever and lethargy, mild thrombocytopenia, leukopenia, and lymphopenia, and was caused by multidrug-resistant (MDR)  Acinetobacter baumannii , confirmed through blood culture. Initial empirical treatment with vancomycin and gentamicin was adjusted to gentamicin and meropenem based on the antibiogram, resulting in a swift and favorable clinical and laboratory response. This case, a rare occurrence in our NICU, provides an opportunity to discuss the etiology, risk factors, and clinical presentation of LOS related to Acinetobacter baumannii, as well as to highlight the growing concern of MDR microorganisms in the NICU setting., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Oliveira Martins et al.)