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.