Sulbactam/Durlobactam for CRAB Bacteremia and Pneumonia in a Critically Ill Patient in China: A Case Report.
- 1Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, People's Republic of China.
Abstract
Background
Evidence supporting sulbactam/durlobactam (SUL-DUR) for carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection remains limited, particularly in critically ill patients with multiorgan failure.Case presentation
A 25-year-old man underwent emergency splenectomy for a ruptured splenic artery aneurysm with 7500 mL estimated blood loss. On transfer to our ICU, PaO₂/FiO₂ was 68 mm Hg, consistent with severe ARDS. He subsequently developed a grade B postoperative pancreatic fistula. A quality-graded sputum specimen grew carbapenem-resistant Klebsiella pneumoniae and CRAB, and a peripheral blood culture drawn during cefoperazone-sulbactam therapy grew CRAB, indicating breakthrough bacteremia; the blood isolate was susceptible to SUL-DUR but resistant to both carbapenems. Ceftazidime-avibactam was replaced with imipenem-cilastatin plus SUL-DUR for eight days, with nebulized colistimethate sodium. Concurrent care included source control, prone ventilation, and pancreatic collection drainage. Procalcitonin had normalized before SUL-DUR began, whereas IL-6 and hs-CRP rose around the positive blood culture and fell during SUL-DUR; he was extubated on ICU day 27. A post-extubation withdrawal episode with convulsions, bronchospasm, and lactic acidosis resolved with rescue sedation. He was discharged from the ICU on June 17, 2026, with negative follow-up blood cultures, and remained well at outpatient review on July 30.Conclusion
This case adds real-world experience regarding the potential role of SUL-DUR in CRAB bacteremia with pneumonia. Because recovery occurred alongside source control, ventilatory support, and sequential antimicrobial therapy, the outcome cannot be attributed to SUL-DUR alone. Larger prospective studies are required to define its role in CRAB bloodstream infection.
Related
- Cost-Effectiveness of Sulbactam-durlobactam Compared with Colistin for Treating Carbapenem-Resistant Acinetobacter baumannii Infections in Critical Care Settings in the United States
- Clinical characteristics, molecular features and in vitro susceptibility to sulbactam-durlobactam, cefiderocol, and eravacycline in NDM-1-producing versus OXA-23-producing carbapenem-resistant Acinetobacter baumannii isolates from children in Guangxi, China.
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BibTeX
@article{deng2026sulbactamdurlobactam,
title = {{Sulbactam/Durlobactam for CRAB Bacteremia and Pneumonia in a Critically Ill Patient in China: A Case Report.}},
author = {Hongsheng Deng and Kun Chen and Ke Chen},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s629147},
url = {https://europepmc.org/article/MED/42948314},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Sulbactam/Durlobactam for CRAB Bacteremia and Pneumonia in a Critically Ill Patient in China: A Case Report.
AU - Hongsheng Deng
AU - Kun Chen
AU - Ke Chen
PY - 2026
DA - 2026/10/23
JO - Infection and drug resistance
DO - 10.2147/idr.s629147
UR - https://europepmc.org/article/MED/42948314
AB - Background Evidence supporting sulbactam/durlobactam (SUL-DUR) for carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection remains limited, particularly in critically ill patients with multiorgan failure.Case presentation A 25-year-old man underwent emergency splenectomy for a ruptured splenic artery aneurysm with 7500 mL estimated blood loss. On transfer to our ICU, PaO₂/FiO₂ was 68 mm Hg, consistent with severe ARDS. He subsequently developed a grade B postoperative pancreatic fistula. A quality-graded sputum specimen grew carbapenem-resistant Klebsiella pneumoniae and CRAB, and a peripheral blood culture drawn during cefoperazone-sulbactam therapy grew CRAB, indicating breakthrough bacteremia; the blood isolate was susceptible to SUL-DUR but resistant to both carbapenems. Ceftazidime-avibactam was replaced with imipenem-cilastatin plus SUL-DUR for eight days, with nebulized colistimethate sodium. Concurrent care included source control, prone ventilation, and pancreatic collection drainage. Procalcitonin had normalized before SUL-DUR began, whereas IL-6 and hs-CRP rose around the positive blood culture and fell during SUL-DUR; he was extubated on ICU day 27. A post-extubation withdrawal episode with convulsions, bronchospasm, and lactic acidosis resolved with rescue sedation. He was discharged from the ICU on June 17, 2026, with negative follow-up blood cultures, and remained well at outpatient review on July 30.Conclusion This case adds real-world experience regarding the potential role of SUL-DUR in CRAB bacteremia with pneumonia. Because recovery occurred alongside source control, ventilatory support, and sequential antimicrobial therapy, the outcome cannot be attributed to SUL-DUR alone. Larger prospective studies are required to define its role in CRAB bloodstream infection.
SN - 1178-6973
ER -