TUNDRA

Recent approval of sulbactam-durlobactam (SUL-DUR) has provided new optimism for the successful treatment of CRAB infections. Indeed, SUL-DUR is the first agent to show improved patient outcomes for CRAB infections in a randomized controlled trial, yet several questions remain unanswered as this agent is introduced into clinical practice. Foremost among them is whether SUL-DUR will be effective alone or if efficacy is optimized when combined with another agent. If used in combination, the preferred combination agent remains to be defined, but may not be imipenem-cilastatin that was studied in the ATTACK trial. Combination therapy is particularly important in the context of polymicrobial infections where DUR may play a complementary role in eradicating infections caused by other β-lactamase producing Gram-negative pathogens. Other questions regarding the efficacy of SUL-DUR include how variation in CRAB molecular epidemiology impacts treatment response,⁵ whether severity of illness impacts decisions to use combination therapy, and how prior antibiotic exposures will impact the in vitro activity of SUL-DUR. There is a clear and pressing need to close these and other important knowledge gaps surrounding the optimal use of SUL-DUR through real-world evidence studies.