A 66-year-old butcher was admitted to the hospital with a sudden high fever, impaired consciousness and persistent restlessness. Neurological examination revealed neck stiffness, a chin-to-chest distance of four fingers, and a positive Kernig sign. The diagnosis of meningitis caused by Streptococcus suis was confirmed by metagenomic capture sequencing, CSF culture and blood culture. The patient had previously been empirically treated with cephalosporins without satisfactory effect, so he received vancomycin 1 g intravenously every 12 hours. He was additionally given mannitol to reduce intracranial pressure, ulinastatin for anti-inflammatory effects and strengthening of immunity, as well as vancomycin 20 mg by intrathecal injection. The patient's condition improved, he was discharged from the hospital and had no special problems during follow-up. The article suggests vancomycin as an antibiotic treatment plan and emphasizes the importance of intrathecal injection in severe cases of resistant CNS infections.