Extract:
“Acinetobacter baumanii-calcoaceticus complex most commonly causes pneumonia and bacteraemia, but osteomyelitis can occur in post-surgical or trauma patients and often requires prolonged treatments of 6 weeks or more. Most of this duration is in the outpatient setting, often through outpatient parenteral antibiotic therapy (OPAT) programmes. The 2024 Infectious Diseases Society of America multi-drug resistant (MDR) guidance documents recommend sulbactam-durlobactam 2 g every 6 hours as first line for treatment of carbapenem-resistant Acinetobacter baumanii (CRAB). Recommended alternative regimens include high-dose ampicillin-sulbactam 9 g every 8 hours in combination with one other active agent, including polymyxin B, minocycline or cefiderocol 2 g every 8 hours. The 2022 ESCMID guidelines for MDR Gram negatives also recommend combination therapy with two in vitro active antibiotics for severe CRAB infections. They give preference to ampicillin-sulbactam for pneumonia and recommend against cefiderocol. Given the complexity of administration, limited stability data, and cost of these regimens, completing a 6-week course of therapy at home is challenging for both patients and OPAT programmes.”
Reference:White BP, Siegrist EA. Carbapenem-resistant Acinetobacter (CRAB) and outpatient antibiotic therapy (OPAT): between a rock and hard place. JAC Antimicrob Resist. 2025 Nov 6;7(6):dlaf201. doi: 10.1093/jacamr/dlaf201. PMID: 41216354; PMCID: PMC12596178.