Eravacycline–Cefiderocol Combination Therapy for Carbapenem-Resistant Acinetobacter baumannii Infective Endocarditis: A Case Report and Brief Review of the Literature

Lixin Lou,1 Xiaohua Li,1 Peng Zhang,1 Hongyu Wu,1 Haiying Chen,1 Jie Ma,2 Kaiyu Zhang1 1Department of Infectious Diseases and Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China; 2Department of Clinical Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of ChinaCorrespondence: Kaiyu Zhang, Department of Infectious Diseases and Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, No. 1, Xinmin Street, Chaoyang District, Changchun, Jilin, 130000, People’s Republic of China, Tel +86-13578673635, Email [email protected]: Infective endocarditis (IE) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is rare and associated with limited treatment options because of extensive antimicrobial resistance.Case Presentation: We hereby present a case of prosthetic valve endocarditis (PVE) caused by CRAB, presenting with fever, persistent bloodstream infection, cerebellar hemorrhage, and aortic valve vegetation. The application of a novel combination therapy comprising eravacycline and cefiderocol effectively eliminated the bloodstream infection. Concomitantly, the monitoring of adverse reactions and the subsequent adjustment of medication and dosage ensured the favorable safety. Although bloodstream infection and valve vegetation were controlled, progressive perivalvular leakage indicated the need for timely surgical intervention when clinically feasible.Conclusion: This case indicates that eravacycline combined with cefiderocol may represent a novel and effective treatment option for refractory IE caused by carbapenem-resistant Gram-negative pathogens, including PVE caused by CRAB.Keywords: infective endocarditis, carbapenem-resistant Acinetobacter baumannii, clinical manifestations, metagenomic next-generation sequencing, novel combined anti-infective regimen