In Vitro Antibacterial Activity of Sulbactam-Durlobactam and Eravacycline Against Carbapenem-Resistant Acinetobacter baumannii in China and Analysis of Sulbactam-Durlobactam Resistance Mechanisms
By: Xuelian He, Shang Ma, Yanyan Zhou, Jingjuan Wei, Zhongling Zhuo and Liyan Ma
References
- Abdi SN, Ghotaslou R, Ganbarov K, Mobed A, Tanomand A, Yousefi M, Asgharzadeh M, Kafil HS. Acinetobacter baumannii efflux pumps and antibiotic resistance. Infect Drug Resist. 2020 Feb;13:423-34. https://doi.org/10.2147/idr.S228089
- Armalytė J, Jurėnas D, Krasauskas R, Čepauskas A, Sužiedėlienė E. The higBA toxin-antitoxin module from the opportunistic pathogen Acinetobacter baumannii - regulation, activity, and evolution. Front Microbiol. 2018 Apr;9:732. https://doi.org/10.3389/fmicb.2018.00732
- Artuso I, Poddar H, Evans BA, Visca P. Genomics of Acinetobacter baumannii iron uptake. Microb Genom. 2023 Aug;9(8). https://doi.org/10.1099/mgen.0.001080
- Azad MAK, Nation RL, Velkov T, Li J. Mechanisms of polymyxin-induced nephrotoxicity. Adv Exp Med Biol. 2019 Jul;1145:305-19. https://doi.org/10.1007/978-3-030-16373-0_18
- Bateman TJ, Shah M, Ho TP, Shin HE, Pan C, Harris G, Fegan JE, Islam EA, Ahn SK, Hooda Y, et al. A Slam-dependent hemophore contributes to heme acquisition in the bacterial pathogen Acineto-bacter baumannii. Nat Commun. 2021 Nov;12(1):6270. https://doi.org/10.1038/s41467-021-26545-9
- China CAST. China Clinical Antimicrobial Susceptibility Testing Standards. Chin J Lab Med. 2025;48(6):451-460. http://www.chinacast.cn
- CLSI. Performance standards for antimicrobial susceptibility testing: CLSI supplement M100. 34th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2023.
- CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI supplement M100. 35th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2025.
- Espinal P, Pantel A, Rolo D, Marti S, López-Rojas R, Smani Y, Pachón J, Vila J, Lavigne JP. Relationship between different resistance mechanisms and virulence in Acinetobacter baumannii. Microb Drug Resist. 2019 Jun;25(5):752-60. https://doi.org/10.1089/mdr.2018.0182
- Giardina BJ, Shahzad S, Huang W, Wilks A. Heme uptake and utilization by hypervirulent Acinetobacter baumannii LAC-4 is dependent on a canonical heme oxygenase (abHemO). Arch Biochem Biophys. 2019 Sep;672:108066. https://doi.org/10.1016/j.abb.2019.108066
- Gordillo Altamirano F, Forsyth JH, Patwa R, Kostoulias X, Trim M, Subedi D, Archer SK, Morris FC, Oliveira C, Kielty L, et al. Bacteriophage-resistant Acinetobacter baumannii are resensitized to antimicrobials. Nat Microbiol. 2021 Feb;6(2):157-61. https://doi.org/10.1038/s41564-020-00830-7
- Hamidian M, Nigro SJ. Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microb Genom. 2019 Oct;5(10). https://doi.org/10.1099/mgen.0.000306
- Hernández-González IL, Mateo-Estrada V, Castillo-Ramirez S. The promiscuous and highly mobile resistome of Acinetobacter baumannii. Microb Genom. 2022 Jan;8(1):762. https://doi.org/10.1099/mgen.0.000762
- Huang PY, Hsu CK, Tang HJ, Lai CC. Eravacycline: a comprehensive review of in vitro activity, clinical efficacy, and real-world applications. Expert Rev Anti Infect Ther. 2024 Jun;22(6):387-98. https://doi.org/10.1080/14787210.2024.2351552
- Kaye KS, Shorr AF, Wunderink RG, Du B, Poirier GE, Rana K, Miller A, Lewis D, O’Donnell J, Chen L, et al. Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK). Lancet Infect Dis. 2023 Sep;23(9):1072-84. https://doi.org/10.1016/s1473-3099(23)00184-6
- Lim TP, Ong RT, Hon PY, Hawkey J, Holt KE, Koh TH, Leong ML, Teo JQ, Tan TY, Ng MM, et al. Multiple genetic mutations associated with polymyxin resistance in Acinetobacter baumannii. Antimicrob Agents Chemother. 2015 Dec;59(12):7899-902. https://doi.org/10.1128/aac.01884-15
- Mack AR, Hujer AM, Mojica MF, Taracila MA, Feldgarden M, Haft DH, Klimke W, Prasad AB, Bonomo RA. β-Lactamase diversity in Acinetobacter baumannii. Antimicrob Agents Chemother. 2025 Mar;69(3):e0078424. https://doi.org/10.1128/aac.00784-24
- Mariano F, Malvasio V, Risso D, Depetris N, Pensa A, Fucale G, Gennari F, Biancone L, Stella M. Colistin therapy, survival and renal replacement therapy in burn patients: A 10-year single-center cohort study. Int J Gen Med. 2022 May;15:5211-21. https://doi.org/10.2147/ijgm.S357427
- Marino A, Augello E, Stracquadanio S, Bellanca CM, Cosentino F, Spampinato S, Cantarella G, Bernardini R, Stefani S, Cacopardo B, et al. Unveiling the secrets of Acinetobacter baumannii: Resistance, current treatments, and future innovations. Int J Mol Sci. 2024 Jun;25(13):6814. https://doi.org/10.3390/ijms25136814
- McLeod SM, O’Donnell JP, Narayanan N, Mills JP, Kaye KS. Sulbactam-durlobactam: a β-lactam/β-lactamase inhibitor combination targeting Acinetobacter baumannii. Future Microbiol. 2024 Mar;19(7):563-76. https://doi.org/10.2217/fmb-2023-0248
- Mimram L, Timsit JF, Rondinaud E, Le M, Thy M. Eravacycline as a last resort for difficult-to-treat resistant Acinetobacter baumannii infections in critically ill patients: three case reports with pharmacokinetic insights. JAC Antimicrob Resist. 2025 Jun;7(3):dlaf095. https://doi.org/10.1093/jacamr/dlaf095
- National Bacterial Resistance Surveillance Network. National report on bacterial antimicrobial resistance surveillance in China 2021. J Chin J Lab Med. 2023;46(6):566-681.
- Shang H, Wang YS, Shen ZY. National Clinical Laboratory Procedures. People’s Medical Publishing House; 2019.
- Sheldon JR, Skaar EP. Acinetobacter baumannii can use multiple siderophores for iron acquisition, but only acinetobactin is required for virulence. PLoS Pathog. 2020 Oct;16(10):e1008995. https://doi.org/10.1371/journal.ppat.1008995
- Snowdin JW, Mercuro NJ, Madaio MP, Rawlings SA. Case report: Successful treatment of OXA-23 Acinetobacter baumannii neurosurgical infection and meningitis with sulbactam-durlobactam combination therapy. Front Med (Lausanne). 2024 May;11:1381123. https://doi.org/10.3389/fmed.2024.1381123
- Solomkin JS, Gardovskis J, Lawrence K, Montravers P, Sway A, Evans D, Tsai L. IGNITE4: Results of a phase 3, randomized, multicenter, prospective trial of eravacycline vs meropenem in the treatment of complicated intraabdominal infections. Clin Infect Dis. 2019 Aug;69(6):921-9. https://doi.org/10.1093/cid/ciy1029
- Song WY, Jeong D, Kim J, Lee MW, Oh MH, Kim HJ. Key structural elements for cellular uptake of acinetobactin, a major siderophore of Acinetobacter baumannii. Org Lett. 2017 Feb;19(3):500-3. https://doi.org/10.1021/acs.orglett.6b03671
- Tamma PD, Immel S, Karaba SM, Soto CL, Conzemius R, Gisriel E, Tekle T, Stambaugh H, Johnson E, Tornheim JA, et al. Successful treatment of carbapenem-resistant Acinetobacter baumannii meningitis with Sulbactam-Durlobactam. Clin Infect Dis. 2024 Oct;79(4):819-25. https://doi.org/10.1093/cid/ciae210
- Wu HJ, Xiao ZG, Lv XJ, Huang HT, Liao C, Hui CY, Xu Y, Li HF. Drug-resistant Acinetobacter baumannii: From molecular mechanisms to potential therapeutics (Review). Exp Ther Med. 2023 May;25(5):209. https://doi.org/10.3892/etm.2023.11908
- Zhanel GG, Cheung D, Adam H, Zelenitsky S, Golden A, Schweizer F, Gorityala B, Lagacé-Wiens PR, Walkty A, Gin AS, et al. Review of eravacycline, a novel fluorocycline antibacterial agent. Drugs. 2016 Apr;76(5):567-88. https://doi.org/10.1007/s40265-016-0545-8
Language: English
Page range: 210 - 219
Submitted on: Jan 25, 2026
Accepted on: May 6, 2026
Published on: Jun 30, 2026
Published by: Polish Society of Microbiologists
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Related subjects:
© 2026 Xuelian He, Shang Ma, Yanyan Zhou, Jingjuan Wei, Zhongling Zhuo, Liyan Ma, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.