Effectiveness and safety of eravacycline-based regimens for resistant Acinetobacter baumannii infections: a systematic review and meta-analysis

INTRODUCTION Acinetobacter baumannii, particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. This meta-analysis aimed to evaluate the effectiveness and safety of eravacycline versus non – eravacycline-based regimens in adults with resistant A. baumannii infections.METHODS MEDLINE, Embase, and Cochrane Central were searched for studies evaluating eravacycline regimens in hospitalized adults with A. baumannii infection. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Data were analyzed using R statistical software.RESULTS Fifteen studies encompassing 462 patients were included. Populations consisted predominantly of older adults, with respiratory tract infections representing the most common source of infection (77.6%). Carbapenem-resistant A. baumannii accounted for 84.4% of evaluable cases. No statistically significant differences were observed between eravacycline and non – eravacycline-based regimens in all-cause mortality (RR 1.06; 95% CI 0.46–2.47), clinical cure (RR 0.90; 95% CI 0.77–1.07), or microbiological eradication (RR 0.88; 95% CI 0.56–1.37). Complementary single-arm pooled estimates among eravacycline-treated cohorts were favorable.CONCLUSION This meta-analysis strengthens the evidence base for eravacycline effectiveness in resistant A. baumannii infections and supports its consideration when preferred regimens are not feasible; adequately powered randomized trials are needed to define optimal positioning.