探讨舒巴坦-度洛巴坦治疗高毒力肺炎克雷伯菌(Hypervirulent Klebsiella pneumoniae, hvKP)继发耐碳青霉烯类鲍曼不动杆菌(Carbapenem-Resistant Acinetobacter baumannii, CRAB)重症肺炎的疗效及安全性，提高对复杂合并感染的诊治水平。

回顾性分析我院2025年收治的1例极危重hvKP继发CRAB感染肺炎患者资料，系统收集患者流行病学、临床表现、实验室检查[炎症指标、血气分析及宏基因组二代测序(metagenomic next-generation sequencing, mNGS)]、影像学及诊疗经过。结合文献复习该类双重重症感染的发病机制与挽救性治疗策略。

患者37岁，男性，因肛周感染起病，迅速进展为脓毒症休克、急性呼吸衰竭及糖尿病酮症酸中毒。入院体温39.2 ℃，白细胞6.8×10⁹/L(中性粒细胞86.4%)，C反应蛋白(C-reactive protein, CRP) 284.49 mg/L，降钙素原(procalcitonin, PCT) 26.3 ng/ml，白细胞介素-6 (interleukin-6, IL-6)>5 000 pg/ml。第2天血及深部痰mNGS检出hvKP(序列数454和154161条)。第7天胸部CT示双侧新发气胸及多个空洞性实变，肺泡灌洗液确诊CRAB(菌落4＋)。早期美罗培南联合奥马环素、多黏菌素B治疗12 d，患者仍持续高热、咳大量粉红色黏痰，痰培养仍为CRAB(3＋)和hvKP(2＋)。调整为美罗培南1 g q 6 h联合舒巴坦-度洛巴坦2 g q 6 h后，体温正常，痰量减少，氧合显著改善。序贯多黏菌素B联合舒巴坦，第41天脱机，痰CRAB转阴。第55天双肺炎症及气胸吸收出院，无明显肝肾毒性及神经系统毒性反应。

hvKP起病急骤易播散，长程广谱抗菌暴露后极易继发CRAB感染，导致病死率显著升高。早期mNGS精准诊断及源头清创至关重要。舒巴坦-度洛巴坦在传统多药联合治疗失败CRAB重症感染中病原学清除及临床疗效确切，安全性好，可作为极危重耐药菌感染的挽救性治疗策略。

To investigate the clinical efficacy and safety of the novel β-lactam/β-lactamase inhibitor combination, sulbactam-durlobactam, in the salvage treatment of severe pneumonia caused by Hypervirulent Klebsiella pneumoniae (hvKP) complicated by a secondary infection of Carbapenem-Resistant Acinetobacter baumannii (CRAB). This study also reviews relevant literature to enhance the clinical understanding, diagnosis, and management of such complex, life-threatening co-infections.

A comprehensive retrospective analysis was conducted on the clinical data of a critically ill 37-year-old male patient admitted to our hospital in 2025. The patient suffered from severe hvKP pneumonia complicated by a secondary CRAB infection. We systematically collected and evaluated the patient′s epidemiological history, dynamic clinical manifestations, and comprehensive laboratory tests (including detailed inflammatory markers, blood gas analysis, and metagenomic next-generation sequencing [mNGS]). High-resolution chest computed tomography (CT) imaging and the complete clinical treatment course-encompassing multidisciplinary antimicrobial regimen adjustments, surgical debridement, and mechanical ventilation-were thoroughly reviewed. Furthermore, a rigorous literature review was performed to summarize the pathogenic mechanisms, infection control measures, and salvage treatment strategies for this dual critical infection.

The patient initially presented with a perianal soft tissue infection that rapidly progressed to septic shock, acute respiratory failure, and diabetic ketoacidosis. Initial vital signs showed a temperature of 39.2 ℃. Laboratory findings revealed a white blood cell count of 6.8×10⁹/L (86.4% neutrophils), C-reactive protein of 284.49 mg/L, procalcitonin of 26.3 ng/mL and IL-6>5 000 pg/ml. On day 2, mNGS of blood and deep sputum identified hvKP (454 and 154, 161 sequences, respectively). By day 7, chest CT demonstrated new bilateral pneumothoraces and multiple cavitary consolidations, while bronchoalveolar lavage fluid confirmed a secondary CRAB infection (colony count 4+ ). Despite an initial 12-day aggressive empirical regimen of meropenem combined with omadacycline and polymyxin B, the patient maintained a high fever and copious pink frothy sputum; cultures persistently grew CRAB (3+ ) and hvKP (2+ ). The treatment regimen was subsequently adjusted to meropenem (1 g q 6 h) combined with sulbactam-durlobactam (2 g q 6 h). Following this targeted intervention, the patient′s temperature normalized rapidly, sputum volume decreased, and oxygenation improved significantly. After sequential therapy with polymyxin B and sulbactam, mechanical ventilation was successfully discontinued on day 41, and sputum cultures converted to negative for CRAB. By day 55, chest CT showed substantial absorption of the bilateral pneumothoraces and pulmonary exudates, allowing for discharge. No significant hepatic, renal, or neurological toxicities were observed during the extended treatment period.

hvKP infections are characterized by acute onset and aggressive systemic dissemination. Patients with prolonged exposure to broad-spectrum antibiotics and invasive procedures are highly susceptible to secondary CRAB infections, which significantly increase mortality. Early diagnostic integration of mNGS and aggressive surgical source control for primary foci are indispensable. Sulbactam-durlobactam demonstrated qualified microbiological clearance and clinical efficacy with a favorable safety profile in this refractory CRAB infection, succeeding where traditional multidrug regimens failed. It represents a vital salvage therapeutic strategy for critical drug-resistant infections.