Successful treatment of carbapenem-resistant Acinetobacter baumannii and Enterobacterales coinfection with sulbactam-durlobactam combined with aztreonam: a case report.

Abstract

Background: Carbapenem-resistant Gram-negative bacilli (CRGNB) often cause nosocomial infections difficult to treat. Their widespread dissemination, associated high mortality, and increasing disease burden constitute a significant global public health challenge. This situation is further exacerbated by mixed CRGNB infections, which exhibit elevated mortality rates and increased therapeutic complexity. Thus, it is imperative to establish effective antibiotic strategies with minimal adverse effects to address these polymicrobial infections. We present this case to evaluate the efficacy of sulbactam-durlobactam (SUL-DUR) combined with aztreonam for treating mixed carbapenem-resistant Acinetobacter baumannii (CRAB) and metallo-β-lactamase (MBL)-producing carbapenem-resistant Enterobacterales (CRE) infections, also exploring the potential mechanisms.

Case description: An elderly patient with uncontrolled chronic obstructive pulmonary disease (COPD) was admitted presenting with dyspnea, bloody sputum, and somnolence. Etiological workup revealed a pulmonary coinfection with CRAB and MBL-producing CRE. The infection proved refractory to multiple rounds of advanced antibiotic therapy, including meropenem, ceftazidime-avibactam, and a combination of polymyxin B with eravacycline. Guided by antimicrobial susceptibility testing (AST) and clinical guidelines, a regimen of SUL-DUR combined with aztreonam was initiated. This therapeutic strategy led to a successful clinical outcome, with no evidence of disease recurrence during a 2-month follow-up period.

Conclusions: This case highlights the significant efficacy of SUL-DUR combined with aztreonam in managing the clinically formidable challenge of mixed CRAB and MBL-producing CRE infections, offering a valuable reference for treating such conditions.