Therapeutic options for carbapenem-resistant Acinetobacter baumannii infections

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections pose a global health threat due to high mortality, rising resistance, and limited treatment options.

Worldwide, OXA-type carbapenemases are the predominant mechanism of resistance; other mechanisms, including efflux pumps, porin mutations, and, rarely, metallo-β-lactamases, may contribute to resistance in resistant isolates, complicating management. Despite the different publication dates, both the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidance support the use of a combination of at least 2 agents for severe infections, despite a lack of high-quality randomized trial data. 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.