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Efficacy and safety of sulbactam–durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii–calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK) - The Lancet Infectious Diseases


The urgent need for effective antibiotics against carbapenem-resistant Acinetobacter baumannii–calcoaceticus complex (ABC) infections led to a phase 3 randomized controlled trial comparing the efficacy and safety of sulbactam–durlobactam versus colistin. The trial involved adults with confirmed ABC-related infections, such as hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, ventilated pneumonia, or bloodstream infections. Patients received either sulbactam–durlobactam or colistin, in combination with imipenem–cilastatin, as background therapy for 7-14 days.


The primary efficacy endpoint was 28-day all-cause mortality in patients with confirmed carbapenem-resistant ABC. The study concluded that sulbactam–durlobactam was non-inferior to colistin (28-day all-cause mortality of 19% versus 20%). Additionally, sulbactam–durlobactam showed a significantly lower incidence of nephrotoxicity compared to colistin. The trial demonstrated that sulbactam–durlobactam could be an effective intervention in reducing mortality from serious infections caused by carbapenem-resistant ABC, including multidrug-resistant strains.

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