To investigate the efficacy of Sulbactam-Durlobactam combined with Meropenem in treatment of extensively drug-resistant Acinetobacter baumannii (XDR-AB)-associated severe hospital-acquired pneumonia.

Retrospective analysis of a case with severe pneumonia caused by XDR-AB who was admitted to Beijing Anzhen Hospital, Capital Medical University on May 1st, 2025 and relevant literatures were reviewed.

A 76-year-old male was hospitalized due to “recurrent fever accompanied by cough and sputum for 2 days”. Chest CT revealed diffused ground-glass opacities in bilateral lower lobes. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid identified human herpesvirus type 1 (102 reads) infection. Based on the clinical manifestations and laboratory tests, ganciclovir was administered for antiviral treatment, and meropenem combined with vancomycin were used for antibacterial treatment. Hospital-acquired severe pneumonia caused by XDR-AB infection and septic shock occurred during the treatment. XDR-AB was sensitive to Tigecycline, Cotrimoxazole, Eravacycline and Sulbactam-Durlobactam, and the highest body temperature of the patient reached 42 ℃, and levels of inflammatory indicators (count of white blood cells, levels of C-reactive protein and procalcitonin, etc.) increased significantly. After 5 days treatment with Sulbactam-Durlobactam (1.0 g/1.0 g per dose via intravenous drip, every 6 hours) and Meropenem (1.0 g per dose via intravenous drip, every 8 hours), the patient’s infection status improved significantly, and was discharged avoiding endotracheal intubation caused by type Ⅱ respiratory failure. Domestic and international studies had reported successful treatment of XDR-AB infections using Sulbactam-Durlobactam in combination with Imipenem. This case demonstrated that adjusting the treatment regimen based on the patient’s medical history, with the addition of Meropenem, could achieve both clinical cure and microbial eradication.

The combination of Sulbactam-Durlobactam and Meropenem could effectively treat hospital-acquired pneumonia caused by XDR-AB, and can significantly improve the patient’s symptoms and eliminate the pathogens.