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However, whether they outperform contemporary alternative best available therapy (BAT), currently consisting of high-dose ampicillin\/sulbactam (AMP\/SUL)-based regimens, is unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A systematic review was conducted in PubMed and clinical trial registries to assess regimens used in comparator arms in studies comparing CFDC or SUL\/DUR to alternative treatment regimens.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Only 1 relevant study was found for SUL\/DUR (the registrational Phase 3). Almost all (98%) patients enrolled had pneumonia and the comparator arm was colistin\/imipenem, a regimen not recommended for treatment of CRAB infections, especially pneumonia. With regards to CFDC, subgroup analyses (with significant limitations) from 2 randomized trials were disappointing showing higher mortality in CREDIBLE-CR compared to colistin-based treatment and similar mortality in APEKS-NK compared to high-dose meropenem among patients with CRAB infections. The rest (<jats:italic>n<\/jats:italic>\u2009=\u200911) of the trials were observational, predominantly single-center (82%) and retrospective (82%), and all but one were conducted in Italy (91%). Although meta-analyses of observational studies suggest better outcomes with CFDC, the comparator arm was colistin-based in all cases and only a minority of patients had received high-dose AMP\/SUL.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>High-quality evidence supporting use of either CFDC or SUL\/DUR in favor of high-dose AMP\/SUL-based regimens is lacking. This has important stewardship implications. Additionally, both CFDC and SUL\/DUR are much more expensive than AMP\/SUL, an important consideration especially for low-\/mid-income countries. Studies comparing CFDC- and SUL\/DUR-based treatments to contemporary alternative BAT are needed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s15010-025-02527-7","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T03:22:32Z","timestamp":1743996152000},"page":"1563-1574","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Are cefiderocol or sulbactam\/durlobactam better than alternative best available treatment for infection by carbapenem-resistant A. baumannii? A systematic literature review"],"prefix":"10.1007","volume":"53","author":[{"given":"Stamatis","family":"Karakonstantis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Ioannou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diamantis P.","family":"Kofteridis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"issue":"2","key":"2527_CR1","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1093\/jac\/dkz401","volume":"75","author":"S Karakonstantis","year":"2019","unstructured":"Karakonstantis S, Kritsotakis EI, Gikas A. Pandrug-resistant Gram-negative bacteria: a systematic review of current epidemiology, prognosis and treatment options. 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