Combating resistant pathogens: exploring the efficacy of eravacycline utilization in multidrug-resistant infections

ABSTRACT Eravacycline, FDA-approved for complicated intra-abdominal infections, is increasingly used off-label for multidrug-resistant infections, including carbapenem-resistant Enterobacterales, Stenotrophomonas maltophilia, and carbapenem-resistant Acinetobacter baumannii . This retrospective, real-world study aims to evaluate the efficacy and safety of eravacycline for treating multidrug-resistant infections at an academic-based health system in Atlanta, Georgia. A multi-center, retrospective study was conducted on adult patients (≥18 years) who received eravacycline at a 6-hospital health system in Atlanta, Georgia, from 1 October 2022 to 30 June 2024. Patients treated for infections due to vancomycin-resistant Enterococcus, carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii , multidrug-resistant Enterobacterales, or Stenotrophomonas maltophilia were included. The primary endpoint was a composite of treatment failure, defined as inpatient mortality and/or 30-day microbiologic recurrence. Secondary outcomes included safety assessments for adverse events and Clostridioides difficile infection. Multivariate regression was used to identify risk factors for treatment failure. Forty-eight patients were included in this study. The patients’ median age was 57.6 years, with 60.4% female and 54.2% Black. Eravacycline was primarily used for vancomycin-resistant Enterococcus (31.3%), Stenotrophomonas maltophilia (29.2%), and carbapenem-resistant Enterobacterales (20.8%) infections. The median treatment duration with eravacycline was 12.6 days. Treatment failure occurred in 39.6% of patients, while 60.4% of patients experienced survival without recurrence. Adverse events were rare (4.2%). No significant factors for treatment failure were identified in multivariate analysis due to a lack of association. Eravacycline is a well-tolerated option for treating multidrug-resistant infections. Given its favorable safety profile, eravacycline is a promising alternative for infections with limited treatment options. IMPORTANCE The increasing prevalence of multidrug-resistant infections, including carbapenem-resistant Enterobacterales and vancomycin-resistant Enterococcus, has made successful treatment of infections due to these organisms challenging. This study contributes to the growing body of literature on the use of eravacycline for multidrug-resistant infections, offering evidence of its safety and efficacy in this context. However, current guidelines do not widely endorse the use of eravacycline due to limited data despite its potential advantages. Many guideline-recommended treatments for these organisms have significant drawbacks, including substantial toxicity, collateral damage such as resistance selection, increased risk of Clostridioides difficile infection, and higher healthcare costs. Eravacycline may serve as a valuable salvage therapy in such scenarios due to its broad-spectrum activity and lower Clostridioides difficile risk. As resistance patterns evolve, eravacycline’s broad-spectrum activity may become a more used option in the management of difficult-to-treat infections, expanding therapeutic options for patients with few viable antimicrobial therapies.