Efficacy and safety of sulbactam–durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii–calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK)
Published on MedED: 24 May 2023
Type of article: In Brief
Category: Antimicrobials
MedED Catalogue Reference: MIIB001
Category Tag: Infectious Diseases | Antimicrobial Resistance | Pneumonia
Sources: Lancet Infectious Diseases
This study, published in Lancet Infectious Diseases ( May 2023), presents the findings of a phase 3 clinical trial comparing the efficacy and safety of the antibiotic combination sulbactam-durlobactam to colistin for the treatment of serious infections caused by carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (ABC). The trial included adult patients with hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, ventilated pneumonia, or bloodstream infections.
A total of 181 patients were randomly assigned to receive either sulbactam-durlobactam or colistin in combination with imipenem-cilastatin as background therapy for 7-14 days. The primary efficacy endpoint was 28-day all-cause mortality in patients with laboratory-confirmed carbapenem-resistant ABC. The primary safety endpoint was the incidence of nephrotoxicity.
The results showed that sulbactam-durlobactam was non-inferior to colistin in terms of 28-day all-cause mortality. The mortality rate was 19% in the sulbactam-durlobactam group compared to 32% in the colistin group. The incidence of nephrotoxicity was significantly lower with sulbactam-durlobactam (13%) compared to colistin (38%).
The study concludes that sulbactam-durlobactam, when combined with imipenem-cilastatin, can be an effective treatment option for serious infections caused by carbapenem-resistant ABC, including multidrug-resistant strains. The antibiotic combination was well tolerated, and the lower incidence of nephrotoxicity is an important advantage over colistin, which is known to have significant renal toxicity.
These findings highlight the potential of sulbactam-durlobactam as a valuable addition to the antibiotic armamentarium for the treatment of carbapenem-resistant ABC infections. Further research and clinical trials are needed to validate these results and gather more evidence on the efficacy and safety of this antibiotic combination.
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