Ilges Dan, Fu Yakun, Dickinson Drew T, Robinson John C, Speiser Lisa, Nicolau David P
Department of Pharmacy, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Center for Anti-Infective Research & Development, Hartford Hospital, Hartford, Connecticut, USA.
Pharmacotherapy. 2025 Aug;45(8):522-528. doi: 10.1002/phar.70042. Epub 2025 Jul 18.
Carbapenem-resistant Acinetobacter baumannii (CRAB) are difficult-to-treat pathogens that primarily cause health care-associated infections. Sulbactam/durlobactam (SUL/DUR) is a novel antibiotic combination that is uniquely formulated to target CRAB isolates. However, investigations of SUL/DUR's pharmacokinetics in obese patients are limited. Here, we report on the successful treatment of CRAB bacteremia in a patient with acute renal failure and severe obesity (weight 273 kg, body mass index 103 kg/m) with SUL/DUR and meropenem combination therapy. The patient had a calculated creatinine clearance of 25 mL/min and received therapy with intravenous SUL/DUR 1 g/1 g every 8 h over 3 h in combination with intravenous meropenem 500 mg every 8 h to complete 14 days of therapy. Pharmacokinetic analysis revealed target attainment with prolonged half-life (T) and volume of distribution (Vd) of 35.3 h and 81.3 L for sulbactam and 30.5 h and 169.1 L for durlobactam, respectively. Susceptibility testing using the broth disk elution test did not show synergy between SUL/DUR and meropenem. No adverse effects were observed, and the patient achieved clinical cure without recurrence of A. baumannii infection.
耐碳青霉烯鲍曼不动杆菌（CRAB）是难以治疗的病原体，主要引起医疗保健相关感染。舒巴坦/度洛巴坦（SUL/DUR）是一种新型抗生素组合，其独特配方旨在针对CRAB分离株。然而，关于SUL/DUR在肥胖患者中药代动力学的研究有限。在此，我们报告了一名急性肾衰竭和严重肥胖（体重273 kg，体重指数103 kg/m）患者采用SUL/DUR和美罗培南联合治疗成功治愈CRAB菌血症的病例。该患者计算的肌酐清除率为25 mL/min，接受静脉注射SUL/DUR 1 g/1 g每8小时一次共3小时，联合静脉注射美罗培南500 mg每8小时一次的治疗，疗程为14天。药代动力学分析显示，舒巴坦的半衰期（T）和分布容积（Vd）延长，分别为35.3小时和81.3升，度洛巴坦分别为30.5小时和169.1升，达到了目标值。使用肉汤纸片洗脱试验进行的药敏试验未显示SUL/DUR和美罗培南之间有协同作用。未观察到不良反应，患者实现了临床治愈，鲍曼不动杆菌感染未复发。
