Spernovasilis Nikolaos, Ishak Angela, Tsioutis Constantinos, Alon-Ellenbogen Danny, Agouridis Aris P, Mazonakis Nikolaos
Department of Infectious Diseases, German Medical Institute, 4108 Limassol, Cyprus.
Department of Internal Medicine, Henry Ford Hospital, 48202 Detroit, MI, USA.
JAC Antimicrob Resist. 2025 Apr 12;7(2):dlaf055. doi: 10.1093/jacamr/dlaf055. eCollection 2025 Apr.
Carbapenem-resistant (CRAB) is characterized as a critical priority pathogen with restricted therapeutic options. To date, the most effective antimicrobial treatment against this difficult-to-treat bacterial strain has not been established. Sulbactam is a β-lactamase inhibitor with intrinsic activity against this pathogen, however, as a β-lactam, it can be hydrolysed by β-lactamases produced by . High-dose, extended-infusion treatment with sulbactam can overcome this hydrolysis by β-lactamases and is considered an effective therapeutic strategy against CRAB. The aim of this review is to analyse primary and secondary research studies that compare sulbactam-based with other regimens, such as polymyxin-containing regimens, tigecycline-containing regimens and other antimicrobial combinations against CRAB infections, especially ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP) and bacteraemia. Our findings suggest that results are conflicting, mostly because of high heterogeneity among studies. However, in most studies, sulbactam-based regimens have demonstrated comparable, and in several studies more favourable results in contrast to other antimicrobial treatments with respect to clinical cure and mortality in CRAB-associated pneumonia, yet without reaching statistical significance in most cases. The auspicious novel β-lactam/β-lactamase inhibitor combination sulbactam/durlobactam is also discussed, although real-world clinical data regarding its efficacy in CRAB infections are still scarce. More randomized controlled trials comparing sulbactam-based with other regimens are warranted to determine the most effective antimicrobial combination against CRAB infections. Nevertheless, current data suggest that sulbactam could play a major role in this combination treatment.
耐碳青霉烯类（CRAB）被列为具有严重治疗局限性的关键优先病原体。迄今为止，针对这种难以治疗的细菌菌株，尚未确立最有效的抗菌治疗方法。舒巴坦是一种对该病原体具有内在活性的β-内酰胺酶抑制剂，然而，作为一种β-内酰胺，它可被……产生的β-内酰胺酶水解。舒巴坦高剂量延长输注治疗可克服β-内酰胺酶引起的这种水解作用，被认为是针对CRAB的一种有效治疗策略。本综述的目的是分析比较以舒巴坦为基础的治疗方案与其他方案（如含多粘菌素的方案、含替加环素的方案以及其他抗微生物联合方案）治疗CRAB感染，特别是呼吸机相关性肺炎（VAP）、医院获得性肺炎（HAP）和菌血症的一级和二级研究。我们的研究结果表明，结果相互矛盾，主要原因是研究之间存在高度异质性。然而，在大多数研究中，与其他抗微生物治疗相比，以舒巴坦为基础的治疗方案在CRAB相关性肺炎的临床治愈和死亡率方面显示出相当的效果，在一些研究中效果更优，但在大多数情况下未达到统计学意义。还讨论了前景良好的新型β-内酰胺/β-内酰胺酶抑制剂组合舒巴坦/度洛巴坦，尽管关于其在CRAB感染中疗效的真实世界临床数据仍然匮乏。需要更多比较以舒巴坦为基础的治疗方案与其他方案的随机对照试验，以确定针对CRAB感染最有效的抗微生物联合方案。尽管如此，目前的数据表明舒巴坦在这种联合治疗中可能发挥主要作用。
