Objective:

To report an early documented case of culture-proven infected pancreatic necrosis (IPN) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) with concurrent Enterococcus faecium bacteremia, and to describe a salvage regimen combining sulbactam-durlobactam (SUL-DUR) with tigecycline.

Approach:

Key Findings:

• IPN can be confirmed within the first week of SAP in patients with persistent organ failure.
• The combination of SUL-DUR and tigecycline is effective for polymicrobial infections involving CRAB and E. faecium, with clinical improvement observed by day 13.

Interpretation:

The case illustrates a critical gap in antimicrobial guidance for treating polymicrobial infections with multidrug-resistant organisms.

Limitations:

• The study is based on a single case report, limiting generalizability.
• Retrospective analysis may introduce bias in treatment evaluation.

Conclusion:

The combination of SUL-DUR and tigecycline is a rational alternative when carbapenems cannot be used for treating infections involving CRAB and E. faecium.

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