Xacduro (sulbactam-durlobactam) / ZAI Lab, Innoviva - LARVOL DELTA

Antimicrobial activity of sulbactam-durlobactam against Acinetobacter baumannii-calcoaceticus complex strains causing non-respiratory and non-bloodstream infections from the United States (2023-2025). (PubMed, Microbiol Spectr) - "This study aims to evaluate the in vitro activity of sulbactam-durlobactam and comparator antibiotics, including meropenem and cefiderocol against A. baumannii-calcoaceticus complex isolates from non-respiratory and non-bloodstream sources...Minocycline susceptibility was 69.1%, while tigecycline and eravacycline MICs50/90 were 1/4 and 0.5/1 mg/L, respectively...The results are important because they can inform clinicians on the susceptibility profiles of A. baumannii from a variety of infection sources, not just lung and bloodstream. As new antibiotics come onto the market, it is important to continuously assess resistance patterns to inform patient and system-wide health decisions."

Journal • Infectious Disease • Nephrology • Pneumonia • Respiratory Diseases

Real-World Evidence and Multidrug Resistant Infections: How Can We Leverage RWE to Improve Patient Outcome with the Novel Beta-Lactam and Beta-Lactam/Beta-Lactamase Inhibitor Combinations. (PubMed, Infect Drug Resist) - "A comprehensive literature search was performed on PubMed-MEDLINE from January 2015 to September 2025 for identifying pivotal trials and real-world evidence concerning the use of cefiderocol and of novel beta-lactam/beta-lactamase inhibitor combination (BL/BLIc) including those of tomorrow (ie, ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefepime-enmetazobactam, cefepime-taniborbactam, cefepime-zidebactam, sulbactam-durlobactam, aztreonam-avibactam). Real-world evidence concerning both well-designed observational studies and PK/PD models may represent a mandatory tool for overcoming issues associated with pivotal trials evaluating novel BL/BLIc. The implementation of dedicated well-designed real-world studies would be warranted for ensuring a constant update of proposed therapeutic algorithms."

HEOR • Journal • Real-world evidence • Review • Infectious Disease

Efficacy and safety of sulbactam/durlobactam for the treatment of patients with ventriculitis due to carbapenem-resistant Acinetobacter baumannii (ESCMID Global 2026) - No abstract available

Clinical

A case series of sulbactam/durlobactam for the treatment of carbapenem-resistant Acinetobacter baumannii bloodstream infections (ESCMID Global 2026) - No abstract available

Clinical • Infectious Disease

Clinical observation of sulbactam-durlobactam in treating multisite infections caused by carbapenem-resistant Acinetobacter baumannii in critically ill patients (ESCMID Global 2026) - No abstract available

Clinical • Infectious Disease

Sulbactam/durlobactam in the treatment of severe pneumonia with sepsis caused by carbapenem-resistant Acinetobacter baumannii: two case reports (ESCMID Global 2026) - No abstract available

Case report • Clinical • Infectious Disease • Pneumonia • Respiratory Diseases • Septic Shock

CSF therapeutic drug monitoring demonstrates efficacy of IV sulbactam/durlobactam for CRAB CNS infections (ESCMID Global 2026) - No abstract available

Clinical • Infectious Disease

Successful use of sulbactam/durlobactam to treat severe pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a extreme-elderly patient (ESCMID Global 2026) - No abstract available

Clinical • Infectious Disease • Pneumonia • Respiratory Diseases

Unveiling the potential resistance mechanisms of Acinetobacter baumannii to sulbactam/durlobactam through in vitro experimental evolution (ESCMID Global 2026) - No abstract available

Preclinical

A multi-site study comparing a commercially prepared dried MIC susceptibility system to the CLSI/ISO broth microdilution method for sulbactam/durlobactam (SE4) using Acinetobacter spp. (ESCMID Global 2026) - No abstract available

In vitro activity of sulbactam-durlobactam against global clinical Acinetobacter baumannii-calcoaceticus complex isolates collected in 2024 (ESCMID Global 2026) - No abstract available

Preclinical

Reassessing β-lactamase inhibition strategies for carbapenem-resistant Acinetobacter: a comparative analysis of in vitro activities of sulbactam/durlobactam vs sulbactam/avibactam (ESCMID Global 2026) - No abstract available

Preclinical

Emergence of sulbactam/durlobactam resistance: an endemic clone of carbapenem-resistant Acinetobacter baumannii bacteraemia isolates (Türkiye, 2019–2023) (ESCMID Global 2026) - No abstract available

Pharmacodynamic activity of sulbactam/durlobactam and ampicillin/sulbactam combinations against Acinetobacter baumannii (ESCMID Global 2026) - No abstract available

PK/PD data

In vitro interactions of sulbactam/durlobactam in combination with meropenem, ceftazidime/avibactam, piperacillin/tazobactam, cefiderocol and fosfomycin against carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates (ESCMID Global 2026) - No abstract available

Combination therapy • Preclinical

FORMaT-EVOLVE: Testing a Novel Combination Treatment (Arm D) Versus Standard of Care for Intensive Phase Treatment for Mycobacterium Abscessus Pulmonary Disease in People With or Without Cystic Fibrosis in the Finding the Optimal Regimen for Mycobacterium Abscessus Treatment (FORMaT) Adaptive Platform Trial (clinicaltrials.gov) - P2 | N=300 | Not yet recruiting | Sponsor: The University of Queensland

New P2 trial • Cystic Fibrosis • Genetic Disorders • Immunology • Infectious Disease • Nontuberculous Mycobacterial Disease • Pulmonary Disease • Respiratory Diseases

Global strategies to fight carbapenem-resistant Acinetobacter baumannii (CRAB) infections. (PubMed, Microb Pathog) - "Current treatment strategies are critically evaluated, with emphasis on optimized antibiotic combinations and emerging agents such as sulbactam-durlobactam and cefiderocol, alongside alternative approaches including bacteriophage therapy, antimicrobial peptidomimetics, and immune-modulating adjuncts. In parallel, the review underscores the importance of infection prevention and control measures, antimicrobial stewardship programs, and coordinated global surveillance initiatives in limiting CRAB transmission in high-burden healthcare settings. Collectively, the evidence indicates that effective control of CRAB infections requires a multidisciplinary, multimodal strategy integrating accurate diagnostics, sustainable therapeutic interventions, and robust public health policies to mitigate the escalating global impact of this priority pathogen."

Journal • Review • Critical care • Infectious Disease

Failure of durlobactam to restore the susceptibility to meropenem in carbapenem-resistant Klebsiella pneumoniae. (PubMed, J Glob Antimicrob Resist) - "A KPC-2-producing CRKP with non-susceptibility to meropenem-durlobactam, possibly linking to porin LamB deficiency and absence of outer membrane assembly protein AsmA, was identified. This uncovers a new challenge caused by antimicrobial resistance, calling more surveillance."

Journal • Infectious Disease • Pneumonia

Multidrug-Resistant Acinetobacter baumannii: Resistance Mechanisms, Emerging Therapies, and Prevention-A Narrative Review. (PubMed, Antibiotics (Basel)) - "Resistance is driven by OXA-type carbapenemases (notably OXA-23/24/58), efflux systems (AdeABC/IJK/FGH), porin alterations (CarO, Omp33-36), and lipopolysaccharide (LPS) modifications conferring colistin resistance. Management options include polymyxins, optimized tigecycline dosing, β-lactam/β-lactamase inhibitors, and newer agents such as cefiderocol and sulbactam-durlobactam, though mortality and safety outcomes vary across trials. A comparative table is included, summarizing antimicrobial mechanism coverage, PK/PD parameters, and adverse effects to support regimen selection in ventilator-associated pneumonia (VAP) and bacteremia. Optimized, multimodal approaches integrating timely diagnostics, targeted combination therapies, infection prevention, and antimicrobial stewardship are essential to improve outcomes and limit the spread of MDR and XDR A. baumannii."

Journal • Review • Critical care • Infectious Disease • Pneumonia • Respiratory Diseases

Successful Use of Sulbactam-Durlobactam in Treating Carbapenem-Resistant Acinetobacter baumannii Pneumonia and Sepsis After Liver Transplantation: A Case Report. (PubMed, Am J Case Rep) - "She received combination therapy with SUL-DUR (1 g/1 g every 8 h), meropenem, eravacycline, and neutralized polymyxin B. Blood and sputum cultures confirmed CRAB susceptibility to SUL-DUR. This case supports Phase III trial data and suggests the potential for use in high-risk, immunocompromised populations. Further studies are warranted to validate its clinical role and inform future guidelines for multidrug-resistant infections."

Journal • Hepatology • Infectious Disease • Liver Failure • Pneumonia • Respiratory Diseases • Septic Shock • Transplantation • IL6

In vitro activity of cefepime/zidebactam against sulbactam/durlobactam-susceptible and -resistant Acinetobacter baumannii clinical isolates. (PubMed, J Antimicrob Chemother) - "These results demonstrate that cefepime/zidebactam exhibited potent in vitro antibacterial activity against CRAB producing OXA carbapenemase and support its clinical use against both sulbactam/durlobactam-susceptible or -resistant isolates."

Journal • Preclinical

Resistance to sulbactam/durlobactam in carbapenem-resistant Acinetobacter baumannii in treatment-naive setting: in vitro data and genomic insights from Italian bloodstream isolates. (PubMed, Int J Antimicrob Agents) - "This study provides early evidence of sulbactam/durlobactam resistance in treatment-naïve CRAB from Italy, driven by NDM-1 co-production and PBP alterations. The coexistence of epidemic ST231 and ST837/ST369 clones highlights the need for continuous genomic surveillance and prudent antibiotic stewardship to prevent dissemination of resistant A. baumannii lineages."

Journal • Preclinical

How to Treat Carbapenem-Resistant Acinetobacter baumannii Infections: Current Knowledge and Personal Viewpoints. (PubMed, Infect Dis Clin North Am) - "Colistin-based regimens, despite toxicity and pharmacokinetic limitations, have long been standard therapy. Recent therapeutic advances include cefiderocol and sulbactam/durlobactam, which show potential activity, especially when used in combination regimens."

Journal • Review • Infectious Disease • Pneumonia • Respiratory Diseases

A Study to Assess Sulbactam-durlobactam in Pediatric Patients With Acinetobacter Baumannii-calcoaceticus Complex Infection (clinicaltrials.gov) - P1 | N=48 | Recruiting | Sponsor: Innoviva Specialty Therapeutics | Initiation date: Oct 2025 ➔ Feb 2026

Trial initiation date • Infectious Disease • Pediatrics

In vitro interactions of sulbactam/durlobactam in combination with meropenem, ceftazidime/avibactam, piperacillin/tazobactam, cefiderocol and fosfomycin against carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates. (PubMed, Eur J Clin Microbiol Infect Dis) - "Sulbactam/durlobactam, when combined with piperacillin/tazobactam or ceftazidime/avibactam, showed synergistic activity against 53.8% (7/13) of CRAB isolates and restored meropenem MIC values below the clinical breakpoint in 46.2% (6/13) of them. Our results demonstrate that sulbactam-durlobactam in combination with β-lactams exhibited high in vitro synergistic activity against CRAB strains."

Journal • Preclinical