Co-infection with carbapenem-resistant <i>Acinetobacter baumannii</i> and carbapenem-resistant <i>Klebsiella pneumoniae</i>: a small-sample observational study of the combination regimen containingsulbactam-durlobactam_West China Medical Journal

Authors：

QU Junyan ,  ZONG Zhiyong

Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZONG Zhiyong, Email: zongzhiy@scu.edu.cn

Keywords：

Carbapenem-resistant Acinetobacter baumannii; carbapenem-resistant Klebsiella pneumoniae; sulbactam-durlobactam; therapy

DOI：

10.7507/1002-0179.202602133

Video：

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Objective To evaluate the efficacy of sulbactam-durlobactam based anti-infective therapy in patients co-infected with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods A retrospective analysis was conducted on medical records of patients co-infected with CRAB and CRKP who received sulbactam-durlobactam treatment at West China Hospital, Sichuan University, between January 2025 and January 2026. Data collected included demographic characteristics, underlying diseases, microbiological findings, antimicrobial regimens, and clinical outcomes. Results A total of eight patients were included, with treatment failure in four. Patients who experienced treatment failure predominantly had severe underlying diseases and were immunocompromised. All CRAB isolates tested for resistance genes harbored bla_OXA-23, while CRKP isolates predominantly carried bla_KPC, with three isolates co-producing multiple carbapenemases. The primary treatment regimen was sulbactam-durlobactam combined with ceftazidime-avibactam. Notably, one patients developed CRKP infection during sulbactam-durlobactam therapy for CRAB infection. Conclusions The management of patients co-infected with CRAB and CRKP remains challenging and is associated with poor prognosis. A comprehensive, multimodal approach is urgently needed to reduce mortality in this population.

Citation： QU Junyan, ZONG Zhiyong. Co-infection with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae: a small-sample observational study of the combination regimen containingsulbactam-durlobactam. West China Medical Journal, 2026, 41(3): 393-397. doi: 10.7507/1002-0179.202602133 Copy

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1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
2. Tamma PD, Heil EL, Justo JA, et al. Infectious diseases society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis, 2024: ciae403.
3. Kaye KS, Shorr AF, Wunderink RG, 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, 23(9): 1072-1084.
4. McLeod SM, Miller AA, Rana K, et al. Clinical outcomes for patients with monomicrobial vs polymicrobial Acinetobacter baumannii-calcoaceticus complex infections treated with sulbactam-durlobactam or colistin: a subset analysis from a phase 3 clinical trial. Open Forum Infect Dis, 2024, 11(4): ofae140.
5. Fouad A, Nicolau DP, Gill CM. In vitro synergy of the combination of sulbactam-durlobactam and cefepime at clinically relevant concentrations against A. baumannii, P. aeruginosa and Enterobacterales. J Antimicrob Chemother, 2023, 78(12): 2801-2809.
6. 醫院感染病例判定標準: 通用原則 WS/T 857—2025 . 中國感染控制雜志, 2025, 24(8): 1175-1177.
7. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017.
8. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 35th ed. CLSI supplement M100. Clinical and Laboratory Standards Institute, USA, 2026.
9. 曾玫, 夏君, 宗志勇, 等. 碳青霉烯類耐藥革蘭陰性菌感染的診斷、治療及防控指南. 中國感染與化療雜志, 2024, 24(2): 135-151.
10. Lv D, Zuo Y, Wang Y, et al. Predictors of occurrence and 30-day mortality for co-infection of carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii. Front Cell Infect Microbiol, 2022, 12: 919414.
11. Lazar V, Holban AM, Curutiu C, Chifiriuc MC. Modulation of quorum sensing and biofilms in less investigated Gram-negative ESKAPE pathogens. Front Microbiol, 2021, 12: 676510.
12. Meya DB, Williamson PR. Cryptococcal disease in diverse hosts. N Engl J Med, 2024, 390(17): 1597-1610.
13. Yang DH, England MR, Salvator H, et al. Cryptococcus gattii species complex as an opportunistic pathogen: underlying medical conditions associated with the infection. mBio, 2021, 12(5): e0270821.
14. Hsu AP, Sampaio EP, Khan J, et al. Mutations in GATA2 are associated with the autosomal dominant and sporadic monocytopenia and mycobacterial infection (MonoMAC) syndrome. Blood, 2011, 118(10): 2653-2655.
15. Lionakis MS. Exploiting antifungal immunity in the clinical context. Semin Immunol, 2023: 101752.
16. 王艷, 崔佳, 王丹丹, 等. 碳青霉烯肺炎克雷伯菌肺炎患者共病因素與患者住院期間死亡相關因素的分析. 中華預防醫學雜志, 2024, 58(11): 1705-1710.
17. Jani BD, Hanlon P, Nicholl BI, et al. Relationship between multimorbidity, demographic factors and mortality: findings from the UK biobank cohort. BMC Med, 2019, 17(1): 74.
18. Fan R, Zuo Y, Wang B, et al. Clinical characteristics, virulence profile, and molecular epidemiology of Klebsiella pneumoniae infections in kidney transplant recipients. Infect Drug Resist, 2025, 18: 1303-1311.
19. Seo H, Kim HJ, Kim MJ, et al. Comparison of clinical outcomes of patients infected with KPC- and NDM-producing Enterobacterales: a retrospective cohort study. Clin Microbiol Infect, 2021, 27(8): 1167. e1-1167. e8.
20. Ramírez M. Multiple organ dysfunction syndrome. Curr Probl Pediatr Adolesc Health Care, 2013, 43(10): 273-277.
21. Li S, Duan X, Peng Y, et al. Molecular characteristics of carbapenem-resistant Acinetobacter spp. from clinical infection samples and fecal survey samples in Southern China. BMC Infect Dis, 2019, 19(1): 900.
22. Zhang Q, Fang Z, Fang B, et al. Clinical epidemiological analysis of the genotypic spectrum and mortality risk in carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. Can J Infect Dis Med Microbiol, 2026, 2026: 1529426.
23. Thomas GR, Corso A, Pasterán F, et al. Increased detection of carbapenemase-producing Enterobacterales bacteria in Latin America and the caribbean during the COVID-19 pandemic. Emerg Infect Dis, 2022, 28(11): 1-8.
24. Vásquez-Ponce F, Dantas K, Becerra J, et al. Detecting KPC-2 and NDM-1 coexpression in Klebsiella pneumoniae complex from human and animal hosts in South America. Microbiol Spectr, 2022, 10(5): e0115922.
25. Pan American Health Organization (PAHO). Epidemiological alert: emergence and increase of new combinations of carbapenemases in Enterobacterales in Latin America and the Caribbean. PAHO, 2021-10-22.
26. Vásquez-Ponce F, Vianello M, Becerra J, et al. Global epidemiological trend of Klebsiella pneumoniae ST340: emergence of subclade KL15 co-producing K pneumoniae carbapenemase-2 and New Delhi metallo-β-lactamase-7 in the Americas. Lancet Microbe, 2025, 6(2): 100990.
27. Zhang F, Liu X, Li Z, et al. Tracking international and regional dissemination of the KPC/NDM co-producing Klebsiella pneumoniae. Nat Commun, 2025, 16(1): 5574.
28. Han R, Shi Q, Wu S, et al. Dissemination of carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) among carbapenem-resistant Enterobacteriaceae isolated from adult and children patients in China. Front Cell Infect Microbiol, 2020, 10: 314.
29. Iovleva A, Fowler VG Jr, Doi Y. Treatment approaches for carbapenem-resistant Acinetobacter baumannii infections. Drugs, 2025, 85(1): 21-40.
30. Wang L, Zhu J, Chen L, et al. Cefiderocol: clinical application and emergence of resistance. Drug Resist Updat, 2024, 72: 101034.
31. Ho CS, Wong CTH, Aung TT, et al. Antimicrobial resistance:a concise update. Lancet Microbe, 2025, 6(1): 100947.
32. Yan H, Wu N, Zhou J, et al. Personalized aerosolized bacteriophage treatment of a pulmonary infection due to carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae in an infant. Int J Infect Dis, 2025, 160: 108075.

West China Medical Journal

Co-infection with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae: a small-sample observational study of the combination regimen containingsulbactam-durlobactam

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