Sulbactam-Durlobactam for CRAB Meningitis

Sulbactam-Durlobactam for CRAB Meningitis

This study reports a case of a 42-year-old woman who successfully recovered from Carbapenem-Resistant Acinetobacter baumannii/calcoaceticus complex (CRAB) meningitis after being treated with sulbactam-durlobactam and meropenem. Despite initial treatment with high-dose ampicillin-sulbactam and cefiderocol, the patient’s CSF cultures remained positive for 13 days. After transitioning to the combination of sulbactam-durlobactam and meropenem, her infection cleared. The study also highlights a potential paradoxical effect of cefiderocol, where bacterial growth is observed at lower dilutions but not at higher dilutions. This effect is likely due to mutations in the TonB-dependent iron transport pathway, which can lead to cefiderocol resistance. Reference Tamma PD, Immel S, Karaba SM, et al. Successful treatment of carbapenem-resistant Acinetobacter baumannii meningitis with sulbactam-durlobactam. Clinical Infectious Diseases. 2024;79(4):819-825.