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Sulbactam/Durlobactam for CRAB Bacteremia and Pneumonia in a Critically Ill Patient in China: A Case Report

Year: 2026

Type: article

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, PaO 2 /FiO 2 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. Keywords: splenic artery aneurysm, postoperative pancreatic fistula, acute respiratory distress syndrome, carbapenem-resistant Acinetobacter baumannii , sulbactam/durlobactam, CRAB bacteremia, intensive care unit

Source: Infection and Drug Resistance

DOI: 10.2147/idr.s629147

Authors: Hongsheng Deng, Kun Chen, Ke Chen

Institution: Jinhua Central Hospital

Language: English

Topic: Antibiotic Resistance in Bacteria

Subfield: Molecular Medicine

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836