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Introduction: Due to the limited therapeutic options for patients with Acinetobacter baumannii complex infections, a new combination antimicrobial agent, sulbactam–durlobactam, has been developed. In this systematic review, we evaluated the available data on the resistance of A. baumannii complex clinical isolates to sulbactam–durlobactam. Methods: We performed a thorough search of four databases for relevant studies. The Clinical and Laboratory Standards Institute (CLSI) sulbactam–durlobactam breakpoint for A. baumannii complex susceptibility was used (MIC value ≤4 mg/L). Data on the presence of genes of various β-lactamases were also analyzed. Results: From 182 identified articles, 84 were thoroughly screened. Data extraction was performed on 20 articles (published 2017–2025) reporting on a total of 10,412 A. baumannii complex clinical isolates. Among the various β-lactamases genes present, the OXA subvariants OXA-23/OXA-23-like were the most common (in 561 isolates). The proportions of non-selected (consecutive) A. baumannii isolates found to be resistant to sulbactam–durlobactam were 1.2%, 1.2%, and 4.6% in the three studies, and with non-susceptibility (resistance and intermediate resistance) were 2%, 2.1%, and 4.6% in three other studies. Non-susceptibility was very rare among A. calcoaceticus, A. nosocomialis, and A. pittii isolates (0%, 0.3%, and 0.6%, respectively). The proportion of carbapenem-resistant A. baumannii isolates with resistance was 0–5.2%. The proportion of A. baumannii isolates selected for their reduced susceptibility profile (including reduced susceptibility to cefiderocol) with resistance was 1.4–27.3%. Discussion: The low proportion of sulbactam–durlobactam resistance among A. baumannii complex isolates supports the consideration of the use of this new antibiotic for its approved indications.
Falagas et al. (Mon,) studied this question.