Acinetobacter baumannii Complex Infections: New Treatment Options in the Antibiotic Pipeline

Acinetobacter baumannii complex (ABC) can result in a panoply of severe syndromes, including pneumonia and septic shock. Options available for treating infections caused by ABC and, more importantly, by carbapenem-resistant ABC (CRAB) are limited because of the increasing prevalence of antimicrobial resistance. Furthermore, many older agents, such as polymyxin and colistin, have limited lung penetration and are associated with significant toxicities. These factors underscore the urgent need for new paradigms to address ABC and CRAB. Two agents, cefiderocol and sulbactam-durlobactam, are now available to treat CRAB infections. In addition, several anti-infectives that target CRAB are in later-stage clinical trials. In order to place these newer molecules in context and to help clinicians appreciate the emerging potential drug development pipeline, we describe the in vitro activity, mechanisms of action, and clinical trial data not only for the commercially now available alternatives, such as cefiderocol and sulbactam-durlobactam, but also review these topics for molecules undergoing phase II and III clinical trials. Specifically, we discuss and analyze data related to four novel drugs from ABC: BV-100, cefepime-zidebactam, zosurabalpin, and OMN6.