Comparative between eravacycline and best available therapy in carbapenem-resistant Acinetobacter baumannii HAP/VAP in China: a retrospective real-world multicenter cohort study.

OBJECTIVES

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major cause of hospital- and ventilator-associated pneumonia (HAP/VAP) with limited treatment options. Eravacycline (ERA) shows potent in vitro activity and favorable pulmonary pharmacokinetics, but clinical evidence for CRAB HAP/VAP remains scarce. We evaluated the real-world effectiveness and safety of ERA.

METHODS

We conducted a retrospective multicenter cohort study at 12 hospitals in China (April 2022-March 2024). Adults with microbiologically confirmed CRAB HAP/VAP treated with ERA or best available therapy (BAT) for ≥ 4 days were propensity scores matched. Primary outcomes were clinical success at end of treatment (EOT) and 28-day mortality.

RESULTS

After 3349 patients screened, 382 were included (ERA 204; BAT 178). Baseline characteristics were balanced. Clinical success at EOT was higher with ERA than BAT (63.2% vs 55.1%), while 28-day mortality was similar (40.1% vs 42.0%). ERA achieved higher microbiological eradication at EOT (45.1% vs 32.0%) and day 14 (36.8% vs 22.5%). Adverse events occurred less frequently with ERA. In targeted first-line treatment, ERA showed higher clinical success, greater microbiological eradication and faster clinical response without increased mortality.

CONCLUSION

Eravacycline improved microbiological clearance, clinical response, and safety compared with BAT for CRAB HAP/VAP, particularly when used as targeted first-line therapy.