Real-world use of eravacycline for the treatment of mono- and polymicrobial infections involving Enterobacterales

Bacterial species in the Enterobacterales order are commonly encountered causative organisms in hospital-acquired infections. Furthermore, the incidence of carbapenem-resistant Enterobacterales (CRE) is a growing threat worldwide. Eravacycline (ERV) is a broad-spectrum fluorocycline antibiotic with activity against Enterobacterales, including CRE, and is approved for the treatment of complicated intra-abdominal infections (cIAI) in the United States and Europe. We conducted a subpopulation analysis of a previously published real-world study evaluating the efficacy of eravacycline for the treatment of infections involving Enterobacterales. Adult patients who received eravacycline for ≥72 h for any infection type involving an Enterobacterales organism were included. The primary outcome was clinical success, and secondary outcomes comprised 30-day all-cause and in-hospital mortality, 30-day microbiological and symptomatic recurrence, and 30- and 60-day hospital readmission. A total of 155 patients were eligible for inclusion. The primary causative organisms were <i>Klebsiella pneumoniae</i> (34.2%), <i>Escherichia coli</i> (32.9%), and <i>Enterobacter cloacae</i> (31.3%), and 23.9% were CRE. A majority of infections (77.4%) were polymicrobial. The most common infection types were intra-abdominal (34.8%), skin and soft tissue (25.2%), and pneumonia (17.4%). The predominant rationale for ERV use was consolidation of the antibiotic regimen (56.8%), and the median (interquartile range) ERV duration was 6.0 days (3.3-12.0). Clinical success was observed in 84.5% of patients. The 30-day all-cause and infection-related mortality were 13.5% and 8.4%, respectively. Microbiological recurrence was low (1.3%), and the 30-day hospital readmission rate was 16.9%. Eravacycline was well-tolerated, with 8.3% of patients experiencing treatment-emergent adverse events (TEAE) and 0.6% resulting in discontinuation of ERV.IMPORTANCEAs the incidence of infections caused by carbapenem-resistant Enterobacterales (CRE) continues to rise globally, novel therapeutic approaches are necessary to combat these difficult-to-treat infections. While β-lactams remain the mainstay of therapy for these patients, increasing rates of metallo-β-lactamase-producing organisms render nearly all β-lactam antibiotics ineffective. Furthermore, >15% of carbapenem-resistant Enterobacterales are non-carbapenemase-producing, circumventing the benefits provided by co-administration of β-lactamase inhibitors. Eravacycline (ERV) is a promising non-β-lactam antibiotic with a broad spectrum of activity, including methicillin-resistant <i>Staphylococcus aureus</i>, vancomycin-resistant Enterococci, and carbapenem-resistant Enterobacterales. Few data exist on the real-world use of eravacycline for the treatment of Enterobacterales infections specifically. In this study, we assessed the safety and effectiveness of eravacycline for the treatment of Enterobacterales infections in a real-world setting. These findings suggest that eravacycline may be a viable therapeutic agent for these infections, expanding our treatment options for multidrug-resistant (MDR) pathogens.