Case Report: Successful salvage therapy with sulbactam-durlobactam combined with meropenem for carbapenem-resistant Acinetobacter baumannii bloodstream infection in a child after failure of allogeneic hematopoietic stem cell transplantation.

Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) constitute a serious complication in patients undergoing hematopoietic stem cell transplantation (HSCT), with pediatric patients facing particularly formidable therapeutic challenges. The phase III ATTACK trial demonstrates that sulbactam-durlobactam (SUL-DUR), a novel β-lactam-β-lactamase inhibitor combination is non-inferior to colistin and is associated with fewer adverse events in adults. However, evidence for SUL-DUR use in post-transplant pediatric patients remains extremely limited. This article reports the first global case of a pediatric patient who experienced two successive HSCT failures and was successfully salvaged with SUL-DUR combined with meropenem for CRAB associated BSI after failing to respond to high-dose sulbactam (150 mg/kg/day) and tigecycline during persistent severe neutropenia, providing a novel strategy for managing resistant bacterial infections in high-risk transplant populations.