New Treatment Standard for CRAB Infections
The IDSA now prioritizes a targeted drug regimen for adults with invasive CRAB to improve patient survival and safety.
Updated on Oct. 27, 2026 in COVID-19
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On July 30, 2026, the Infectious Diseases Society of America updated its clinical guidance to designate sulbactam-durlobactam as the preferred treatment for invasive carbapenem-resistant Acinetobacter baumannii (CRAB) infections. This shift moves the therapy to the forefront of care for patients battling these difficult-to-treat bacterial pathogens.
Why it matters
The guidance update aims to improve clinical outcomes for patients by prioritizing a drug specifically engineered to overcome the resistance mechanisms inherent to CRAB. By establishing this as the default target, the IDSA seeks to standardize treatment and reduce reliance on older, more toxic therapeutic options.
In the Phase 3 ATTACK trial involving 181 patients, sulbactam-durlobactam demonstrated a 19% 28-day all-cause mortality rate, compared to 32% for those receiving colistin. The drug also showed a lower incidence of nephrotoxicity at 13%, versus 38% for the colistin group.
The players
Infectious Diseases Society of America
A professional society representing physicians and scientists that publishes evidence-based clinical practice guidelines.
Food and Drug Administration
The federal agency responsible for protecting public health by regulating the safety and efficacy of medical products and pharmaceuticals.
The details
The treatment functions by combining sulbactam, a beta-lactamase inhibitor-based agent, with durlobactam, which protects sulbactam from degradation by enzymes produced by the bacteria. For patients with CRAB, this combination is now the default, often used alongside a carbapenem to maximize efficacy. For cases resistant to this regimen, the guidelines suggest using non-sulbactam agents or supplementing with cefiderocol as bridge therapy.
Timeline
2023: The FDA approved sulbactam-durlobactam for specific bacterial pneumonia cases.
2024: The previous version of the IDSA antimicrobial guidance was released.
July 30, 2026: The IDSA published its updated antimicrobial-resistant infection guidance.
October 2026: IDWeek 2026 took place in Washington, DC.
Health Landscape
This update follows the periodic review cycle of the IDSA antimicrobial-resistant infection guidance. It signals a move away from legacy antibiotics toward targeted therapies designed to neutralize specific bacterial resistance profiles.
Patients and families dealing with serious bacterial infections should ask their clinical care team about whether current therapy aligns with the latest IDSA antimicrobial-resistant infection guidance. Understanding the potential for reduced side effects like nephrotoxicity is an important part of the conversation regarding treatment choice.
The takeaway
The IDSA now prioritizes sulbactam-durlobactam as the default therapy for invasive CRAB to improve survival and safety outcomes. Patients receiving treatment for drug-resistant pneumonia should always discuss the most recent clinical guidelines with their infectious disease specialist.
Further reading
For broader updates on infection management, see the COVID-19 section.
More information
Review the full IDSA antimicrobial-resistant infection guidance for detailed clinical recommendations.
Source note: This article includes information reported by Contagionlive.
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