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

Author Response: Sulbactam-Durlobactam for Carbapenem-resistant Acinetobacter baumannii in India: Does Local Molecular Epidemiology Support Current Guideline Recommendations? and Antibiotic Choice for Carbapenem-resistant Pseudomonas aeruginosa: Need to Look beyond the Forest. (PubMed, Indian J Crit Care Med) - "and Antibiotic Choice for Carbapenem-resistant Pseudomonas aeruginosa: Need to Look beyond the Forest. Indian J Crit Care Med 2026;30(8):702-703."

Journal

Sulbactam-Durlobactam for Carbapenem-resistant Acinetobacter baumannii in India: Does Local Molecular Epidemiology Support Current Guideline Recommendations? (PubMed, Indian J Crit Care Med) - "Mukkelli VG, Gupta R. Sulbactam-Durlobactam for Carbapenem-resistant Acinetobacter baumannii in India: Does Local Molecular Epidemiology Support Current Guideline Recommendations? Indian J Crit Care Med 2026;30(8):698-699."

Journal • Infectious Disease

Newer antibiotics for drug-resistant Gram-negative infections in immunocompromised hosts: from pivotal trials to high-risk practice. (PubMed, Front Cell Infect Microbiol) - "This critical narrative Review integrates 27 pivotal-trial protocol identifiers included in a predefined evidence map, immune-phenotype-specific cohorts, contemporary guidance, pharmacokinetic/pharmacodynamic evidence, and treatment-emergent resistance reports for a bounded core set of newer agents first authorized in the United States or European Union between 2014 and 2025, including newer β-lactam/β-lactamase-inhibitor combinations, cefiderocol, sulbactam-durlobactam, aztreonam-avibactam, and selected non-β-lactams. The Review then synthesizes treatment by resistance mechanism and applies a host-pathogen-drug-context framework to empirical selection, diagnostics, exposure optimization, source control, de-escalation, relapse, and resistance. The resulting evidence map supports mechanism-active therapy while making the limits of transfer auditable and defining priorities for standardized phenotype reporting and pragmatic enrollment."

Journal • Review • Hematological Disorders • Hematological Malignancies • Human Immunodeficiency Virus • Immunology • Infectious Disease • Neutropenia • Oncology • Pediatrics • Primary Immunodeficiency • Solid Organ Transplantation • Solid Tumor • Transplantation

In vitro activity of zosurabalpin against a global set of carbapenem-resistant-A. baumannii clinical isolates. (PubMed, Antimicrob Agents Chemother) - "We compared zosurabalpin's activity with currently available antibiotics, including colistin, cefiderocol, sulbactam-durlobactam, as well as rifabutin. Zosurabalpin MICs in CRAB isolates were generally low, including metallo-β-lactamase-producing-CRAB. The low MICs show a high potential to overcome current treatment limitations; however, mutations in lptD may contribute to resistance emergence and should be further studied."

Journal • Preclinical • Infectious Disease

Molecular epidemiology and genomic characteristics of clinical Acinetobacter baumannii isolates from patients with hospital-acquired pneumonia in China, 2019-2020: a multicentre retrospective study. (PubMed, EBioMedicine) - "This study demonstrates the extremely high prevalence and clonal dominance of CRAB in Chinese patients with HAP, providing critical evidence for clinical treatment, antimicrobial stewardship, and targeted infection control."

Journal • Retrospective data • Infectious Disease • Pneumonia • Respiratory Diseases

A Retrospective Review of Sulbactam/durlobactam (Xacduro®) for the Treatment of Carbapenem – resistant Acinetobacter baumannii Infections at a New York City Hospital (IDWeek 2026) - No abstract available

Retrospective data • Review • Infectious Disease

Low-dose sulbactam-durlobactam for recurrent CRAB pneumonia in a child with cerebral palsy: a Case Report from a resource-limited setting. (PubMed, Front Pharmacol) - "The patient defervesced within 48 h, inflammatory markers declined, chest imaging improved markedly, and he was transferred out of the PICU after 12 days of therapy. A PK/PD-driven low-dose SUL-DUR strategy may represent a feasible and potential cost-saving strategy for pediatric CRAB pneumonia in resource-limited settings."

Journal • Cerebral Palsy • CNS Disorders • Epilepsy • Infectious Disease • Pediatrics • Pneumonia • Respiratory Diseases

Antibiotic Treatment of Severe Infections with Multiresistant Bacteria. (PubMed, Dtsch Arztebl Int) - "The treatment should be tailored in consideration of the site of infection, the antibiotic sensitivity profile, the resistance mechanism, and the clinical situation. New reserve antibiotics should be used selectively and in the framework of antimicrobial stewardship."

Clinical guideline • Journal • Infectious Disease • Pneumonia • Respiratory Diseases

Mechanisms of sulbactam-durlobactam resistance in Acinetobacter baumannii. (PubMed, Trends Microbiol) - "Resistance can be conferred by metallo-β-lactamases alone or penicillin-binding protein 3 alterations plus β-lactamase overproduction or enhanced efflux. Other reported mechanisms remain associative and resistance in guideline-recommended carbapenem addition is unclear, underscoring the need for mechanistic validation and further studies."

Journal

Successful Treatment of Carbapenem-Resistant Acinetobacter baumannii Infection with Sulbactam-Durlobactam: A Two-Case Report. (PubMed, Infect Drug Resist) - "Current guidelines recommend SUL-DUR in combination with imipenem-cilastatin or meropenem for the treatment of CRAB pneumonia. Considering the absence of concurrent bacterial pathogens and concerns regarding additional broad-spectrum antimicrobial exposure, SUL-DUR monotherapy was selected as an individualized treatment strategy and resulted in resolution of fever, improvement of pulmonary lesions, and successful ventilator liberation. These two cases expand the clinical experience of SUL-DUR in severe CRAB infections, demonstrating successful treatment of CRAB bloodstream infection with SUL-DUR-based combination therapy and favorable outcomes of individualized SUL-DUR monotherapy for selected monomicrobial CRAB pneumonia."

Journal • Infectious Disease • Mood Disorders • Pneumonia • Respiratory Diseases

Emergent Sulbactam-Durlobactam Non-Susceptibility in Acinetobacter baumannii: Potential Interplay Between PBP3 and AdeFGH Overexpression. (PubMed, Clin Infect Dis) - No abstract available

Journal

In Vitro Antibacterial Activity of Sulbactam-Durlobactam and Eravacycline Against Carbapenem-Resistant Acinetobacter baumannii in China and Analysis of Sulbactam-Durlobactam Resistance Mechanisms. (PubMed, Pol J Microbiol) - "Despite the extensive-drug-resistant (XDR) nature of current CRAB isolates, they maintain high sensitivity to SUL-DUR and ERV. Our findings underscore that SUL-DUR and ERV represent highly promising therapeutic options with significant development potential and broad clinical application prospects for the management of CRAB-related infections."

Journal • Preclinical • Infectious Disease

Therapeutic options for carbapenem-resistant acinetobacter baumannii infections. (PubMed, Expert Opin Pharmacother) - "Sulbactam/durlobactam is prioritized as the core of treatment in the IDSA guidelines, whereas the ESCMID does not state a preference. Cefiderocol is also a novel cephalosporin suggested for refractory or resistant infections or for those with prior treatment failure, although randomized trial data are inconsistent regarding mortality. Old treatment choices such as carbapenems, polymyxins, and tetracyclines maintain their role as components of a combination treatment in difficult-to-treat infections from CRAB. There is a need to reinforce infection prevention and control measures, conduct further research on novel antibiotics and rapid, accurate diagnostic tests, and obtain high-quality data to support current practice."

Journal • Review • Infectious Disease

Indian Society of Critical Care Medicine Guidelines on Evidence-based Recommendations for the Treatment of Carbapenem-resistant Enterobacterales, Carbapenem-resistant Acinetobacter baumannii, and Carbapenem-resistant Pseudomonas aeruginosa in Critically Ill Patients: A GRADE-guided Approach. (PubMed, Indian J Crit Care Med) - "Fifty-two studies were included: 36 evaluating polymyxin/colistin and 16 evaluating sulbactam...For CRAB, sulbactam-based regimens, particularly sulbactam-durlobactam, showed superior cure rates (61.9 vs 39.7%) and reduced nephrotoxicity (13 vs 38%), supporting a strong recommendation (very low certainty)...Non-polymyxin regimens are preferred for CRE and CRPA, while sulbactam-based therapy is favored for CRAB. This shift away from polymyxin use may improve outcomes and reduce toxicity, though robust randomized trials are urgently needed."

Journal • Critical care • Infectious Disease

Real-World Clinical Outcomes of Sulbactam-Durlobactam Against Carbapenem-Resistant Acinetobacter baumannii with Diverse β-Lactamase Profiles: A Multicenter Study in China. (PubMed, Infect Drug Resist) - "SUL-DUR, administered exclusively as part of combination regimens, was associated with favorable clinical outcomes and a manageable short-term safety profile in this small cohort, including in patients requiring extracorporeal life support and those infected with strains co-harboring multiple β-lactamases. These descriptive findings are hypothesis-generating and, given the small sample size, the absence of a comparator group, and the use of combination therapy in all patients, should be interpreted with caution; any apparent pharmacoeconomic advantage associated with early clinical improvement requires confirmation in controlled studies."

Clinical • Clinical data • Journal • Real-world evidence • Infectious Disease

Case Report: Early documented infected pancreatic necrosis due to carbapenem-resistant Acinetobacter baumannii and concurrent Enterococcus faecium bacteremia: a salvage regimen with sulbactam-durlobactam and tigecycline. (PubMed, Front Med (Lausanne)) - "IPN can be confirmed within the first week of SAP in patients with persistent organ failure and sustained intra-abdominal hypertension, especially in the presence of multidrug-resistant organism colonization. For polymicrobial infections with CRAB and intrinsically carbapenem-resistant E. faecium, the combination of SUL-DUR and tigecycline is a rational alternative when a carbapenem cannot be used."

Journal • Acute Kidney Injury • Cardiovascular • Hypertension • Infectious Disease • Nephrology • Pancreatitis • Renal Disease

A Clinical Case of Treatment-Emergent Acinetobacter baumannii Non-Susceptibility to Sulbactam-Durlobactam. (PubMed, Clin Infect Dis) - "Treatment-emergent mutations in the AdeFGH efflux system were identified, accompanied by a 166-fold increase in adeG expression. Efflux pump inhibition restored sulbactam-durlobactam susceptibility."

Journal

Phenotypic Detection Methods, Clinical Outcomes, and Therapeutic Strategies for OXA-Type Carbapenemase-Producing Acinetobacter Species in an Indian Tertiary Care Setting. (PubMed, Cureus) - "Finally, given the high prevalence of these isolates in Indian intensive care units, this review evaluates the severe clinical outcomes associated with these strains and highlights essential therapeutic strategies. It emphasizes the urgent need for tailored combination therapies and explores the efficacy of novel targeted treatments, such as the sulbactam-durlobactam combination, in managing severe OXA-driven infections."

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

An update on beta-lactam-beta-lactamase inhibitor combinations for the treatment of carbapenem-resistant gram-negative pathogens. (PubMed, Expert Opin Drug Metab Toxicol) - "This expert review summarizes the pharmacology, clinical efficacy, and safety of approved and emerging BLBLIs, including ceftolozane - tazobactam, cefepime - enmetazobactam, ceftazidime - avibactam, meropenem - vaborbactam, imipenem - relebactam, aztreonam - avibactam, and sulbactam - durlobactam. However, their impact is threatened by the rising prevalence of metallo-β-lactamases and the persistent therapeutic gap in carbapenem-resistant A. baumannii. Future success will depend on next-generation inhibitors with broader enzyme coverage, optimized dosing strategies guided by PK/PD principles, and robust antimicrobial stewardship to preserve long-term efficacy."

Journal • Review • Infectious Disease

Salvage Treatment of Ventilator-Associated Pneumonia Using Sulbactam-Durlobactam in a Preterm Neonate: A Case Report. (PubMed, Infect Dis Rep) - "This case highlights the therapeutic challenges of XDR infections in extremely preterm neonates and suggests that sulbactam-durlobactam may represent a viable salvage treatment option. Further pharmacokinetic and clinical studies are needed to establish optimal dosing and safety in the neonatal population."

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

REAL-WORLD EXPERIENCE OF SULBACTAM–DURLOBACTAM IN HEMATOLOGIC MALIGNANCY PATIENTS WITH SUSPECTED CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTION (EHA 2026) - "Summary/Conclusion In this small real-world cohort of heavily pretreated hematologic malignancy patients with limited therapeutic options, sulbactam– durlobactam demonstrated encouraging early clinical responses with acceptable safety. These findings provide preliminary clinical evidence supporting its use in this underrepresented high-risk population and highlight the need for further evaluation."

Clinical • Real-world • Real-world evidence • Acute Kidney Injury • Bone Marrow Transplantation • Hematological Malignancies • Infectious Disease • Nephrology • Neutropenia • Oncology • Renal Disease • Respiratory Diseases

In vitro activity of cefiderocol and sulbactam-durlobactam against clinical-isolated carbapenem-resistant Acinetobacter baumannii from China. (PubMed, Int J Infect Dis) - "Cefiderocol and sulbactam-durlobactam exhibit high in vitro efficacy against Chinese CRAB isolates. Although these agents were not yet approved for clinical use in China at the time of isolate collection, non-susceptibility to cefiderocol or sulbactam-durlobactam was already detected. Resistance to cefiderocol was potentially associated PER-7 β-lactamase and mutations in iron transporters/PBPs, while sulbactam-durlobactam non-susceptibility was potentially correlated with PBP3 substitutions. These findings underscore the need for ongoing surveillance and mechanistic studies to address emerging resistance in CRAB."

Journal • Preclinical

Consistent in vitro activity of sulbactam-durlobactam against genetically diverse carbapenem-resistant Acinetobacter baumannii in a high-endemic Brazilian setting. (PubMed, Antimicrob Agents Chemother) - "Despite genetic and phenotypic diversity, including distinct carbapenemase genes (particularly blaOXA-23-like) and the presence of PBP3 mutations, activity remained consistent. These findings support sulbactam-durlobactam as an effective option against CRAb in this high-endemic setting."

Journal • Preclinical • Infectious Disease

Microbiological eradication of XDR Acinetobacter baumannii intra-abdominal infection using sulbactam-durobactam: clinical and microbiological outcomes amidst irreversible host comorbidities. (PubMed, Front Med (Lausanne)) - "After the failure of an initial salvage regimen comprising polymyxin B, minocycline, and ampicillin-sulbactam, therapy was escalated to sulbactam-durlobactam combined with imipenem-cilastatin. This case suggests the potential utility of sulbactam-durlobactam in combination with a carbapenem for complicated intra-abdominal infection (cIAI) caused by CRAB, highlighting a successful microbiological outcome. However, it also underscores that microbiological eradication does not invariably translate to clinical survival when overwhelming host factors and irreversible comorbidities dictate the ultimate prognosis."

Journal • Cachexia • CNS Disorders • Colorectal Cancer • Infectious Disease • Muscular Atrophy • Myositis • Oncology • Pain • Squamous Cell Carcinoma

Carbapenemases: epidemiology, detection and management in a changing global landscape. (PubMed, JAC Antimicrob Resist) - "Treatment is reviewed in a mechanism-directed manner: newer BL/beta-lactamase inhibitor combinations are central for serine carbapenemases (including KPC and many OXA-48-like producers), whereas MBL producers require alternative strategies such as aztreonam-based combinations or cefiderocol. Options remain limited for carbapenemase-producing P. aeruginosa and A. baumannii, although sulbactam-durlobactam and pipeline agents are expanding the therapeutic landscape. We highlight the widening gap between disease burden and access to rapid diagnostics and novel therapies, particularly in high-burden low- and middle-income settings. Finally, we outline the bundled infection prevention and antimicrobial stewardship interventions needed to contain transmission and preserve the effectiveness of novel agents."

Journal • Review • Infectious Disease • Pneumonia