Unraveling sulbactam-durlobactam: insights into its role in combating infections caused by Acinetobacter baumannii

Abstract

Introduction: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical priority pathogen posing a substantial threat to our public health due to its virulence and resistance to broad-spectrum antimicrobials. Sulbactam-durlobactam (Xacduro) is a newly approved β-lactam-β-lactamase inhibitor combination agent with potent in vitro and in vivo activity against CRAB. The phase III randomized trial (ATTACK) demonstrated the safety and efficacy of sulbactam-durlobactam in combination with imipenem-cilastatin as background therapy in treating adult patients with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia caused by CRAB.

Areas covered: This review will discuss pharmacology, antimicrobial activity, pharmacokinetics/pharmacodynamics, clinical efficacy, safety, and therapeutic role of sulbactam-durlobactam. To gather relevant information, a literature search was performed using PubMed and Google Scholar electronic databases. Search terms used include sulbactam, sulbactam-durlobactam, ETX2514, Acinetobacter baumannii, Acinetobacter baumannii-calcoaceticus complex, CRAB, OXA-24, and OmpA. Additional information was obtained from the sulbactam-durlobactam FDA package insert and infectious diseases conference abstracts.

Expert opinion: Sulbactam-durlobactam is a well-tolerated β-lactam-β-lactamase inhibitor combination agent with efficacy against CRAB. Given the limitations of alternative treatment options, sulbactam-durlobactam may also be considered as a treatment option for non-respiratory infections caused by CRAB, however further clinical studies are warranted.

Keywords: Acinetobacter baumannii-calcoaceticus complex; Carbapenem-resistant A. baumannii; ETX2514; Hospital-acquired bacterial pneumonia; Sulbactam-durlobactam; Ventilator-associated bacterial pneumonia; class D β-lactamases.