Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 6;10(10):ofad504.
doi: 10.1093/ofid/ofad504. eCollection 2023 Oct.

In Vivo Emergence of Pandrug-Resistant Acinetobacter baumannii Strain: Comprehensive Resistance Characterization and Compassionate Use of Sulbactam-Durlobactam

Mollie VanNatta  1 , Laurie Grier  2 , Muhammad H Khan  3 , Paulette Pinargote Cornejo  3 , Mohammad Alam  3 , Samir H Moussa  4 , Jennifer G Smith  1 , Samuel L Aitken  5 , Alexandre E Malek  3
Affiliations

In Vivo Emergence of Pandrug-Resistant Acinetobacter baumannii Strain: Comprehensive Resistance Characterization and Compassionate Use of Sulbactam-Durlobactam

Mollie VanNatta et al. Open Forum Infect Dis. .

Abstract

The treatment of patients with infection secondary to carbapenem-resistant Acinetobacter baumannii with emerging cefiderocol resistance remains challenging and unclear. We present a case of in vivo emergence of pandrug-resistant A baumannii that was successfully treated with the compassionate use of investigational sulbactam-durlobactam-based antibiotic regimen. We also performed a longitudinal genomic analysis of the bacterial isolates and showed the development of resistance and genetic mutations over time.

Keywords: acinetobacter baumannii; antimicrobial resistance; carbapenemresistant acinetobacter baumannii; multiple drug-resistant bacteria; sulbactam-durlobactam.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. S. L. A. serves on the advisory boards for Entasis, GSK, Basilea, bioMérieux, AstraZeneca, Melinta, Shionogi, Ferring, and F2G. S. H. M. is a current employee of Innoviva Specialty Therapeutics, Inc. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Timeline of hospital course with antibiotic usage and Acinetobacter baumannii isolate culture and susceptibility data. Abbreviations: BAL, bronchoalveolar lavage; BID, twice daily; CST, colistin; FDC, cefiderocol; I, intermediate; IJ, intrajugular; IV, intravenous; MEM, meropenem; MIN, minocycline; PMB, polymyxin B; R, resistant; S, sensitive; SAM, ampicillin-sulbactam; SUL-DUR, sulbactam-durlobactam; TGC, tigecycline. aSensitivity performed using disk diffusion. bSensitivity performed in iron-depleted cation-adjusted Mueller-Hinton broth. cPatient was empirically treated with ceftolozane-tazobactam, vancomycin, and trimethoprim-sulfamethoxazole between hospital days 63 and 67. dAgents tested in combination with SUL-DUR were titrated 1:1 with SUL and DUR was fixed at 4 mg/L, based on preliminary breakpoint of 4 mg/L.
See this image and copyright information in PMC

References

    1. Yassin MH, Phan T, Doi Y. Unusual community-associated carbapenem-resistant Acinetobacter baumannii infection, Pennsylvania, USA. IDCases 2020; 21:e00851. - PMC - PubMed
    1. Solak Y, Atalay H, Turkmen K, Biyik Z, Genc N, Yeksan M. Community-acquired carbapenem-resistant Acinetobacter baumannii urinary tract infection just after marriage in a renal transplant recipient. Transpl Infect Dis 2011; 13:638–40. - PubMed
    1. Shenoy ES, Pierce VM, Sater MRA, et al. . Community-acquired in name only: a cluster of carbapenem-resistant Acinetobacter baumannii in a burn intensive care unit and beyond. Infect Control Hosp Epidemiol 2020; 41:531–8. - PubMed
    1. Centers for Disease Control and Prevention. Antibiotic resistance and patient safety portal. Carbapenem-resistant Acinetobacter baumannii (CRAB): an urgent public health threat in United States healthcare facilities.2021. Available at: https://arpsp.cdc.gov/story/cra-urgent-public-health-threat. Accessed 28 November 2022.
    1. Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis 2006; 43(Suppl 2):S49–56. - PubMed