Successful Treatment of OXA-23 Acinetobacter baumannii Pneumonia with Sulbactam-Durlobactam in a Liver Transplant Recipient

Abstract: Liver transplant recipients face a higher risk of multidrug-resistant (MDR) infections because of preoperative comorbidities, extensive antibiotic use, immunosuppressive therapy, and prolonged mechanical ventilation. Carbapenem-resistant Acinetobacter baumannii (CRAB) remains one of the most challenging pathogens in this group. We report a case of a liver transplant recipient with OXA-23-producing Acinetobacter baumannii pneumonia. Initial treatment with polymyxin B and eravacycline produced unsatisfactory results and worsened renal dysfunction during treatment. Later, administration of sulbactam-durlobactam (SUL-DUR) combined with meropenem resulted in significant clinical improvement. Follow-up CT scans showed notable resolution, and the patient successfully recovered, with renal function restored and eventual discharge. This case highlights the difficulty of managing OXA-23-producing Acinetobacter baumannii in liver transplant patients, especially those with kidney impairment. SUL-DUR showed effective therapy with a much lower risk of nephrotoxicity compared to previously used agents. Keywords: liver transplantation, carbapenem-resistant Acinetobacter baumannii , sulbactam-durlobactam, multidrug-resistant infection