Thread by @ErinMcCreary

ATTACK Trial results #ECCMID2022: efficacy & safety of sulbactam-durlobactam (SUL-DUR) vs colistin for Acinetobacter baumannii complex. Sulbactam has intrinsic activity against AB (PBP binding); durlobactam potent inhibition of class A, C,D beta-lactamases
pubmed.ncbi.nlm.nih.gov/28665414/

this was a phase 3 non-inferiority trial of HAP, VAP, BSI randomized 1:1 to SUL-DUR plus IMI or Colistin + IMI. primary efficacy outcome 28-day ACM, safety = nephrotoxicity measured by RIFLE #ECCMID2022

study enrollment was as follows, 95% of isolates were CRAB #ECCMID2022

while the study used imipenem as the partner carbapenem, meropenem likely okay as well based on HFIM results presented. there's also one published case report on use in combo with FDC pubmed.ncbi.nlm.nih.gov/34370576/ #ECCMID2022

baseline characteristics well matched, but more ventilated patients in SUL-DUR group #ECCMID2022

here's the money shot: efficacy endpt achieved! 19% ACM SUL-DUR vs 32.3% in colistin. this is SUPER exciting as seemingly we finally have a drug that works for CRAB. however, have to point out that ACM rate in SUL-DUR is 1% higher than BAT @ 28d for FDC in CREDIBLE #ECCMID2022

more clinical cure and safer than colistin, this is exciting stuff #ECCMID2022

the results of the part B, open label aspect of the trial were also presented #ECCMID2022

in conclusion,SUL-DUR could be a promising addition to the CRAB toolkit which is currently somewhat of a hot mess. authors stated they did WGS of isolates, haven’t reported results out, looking at efficacy across geographies the results are consistent across endpoints #ECCMID2022