Real-World Therapy with Eravacycline for Complex Infections Caused by Carbapenem-Resistant Pathogens with a Focus on Patients with Severe Burns

Abstract

The purpose of this study was to describe the clinical outcomes in patients with complex infections caused by carbapenem-resistant pathogens who were treated with eravacycline (ERV) containing regimens. A retrospective chart review was conducted at Hospital St. Georg in Leipzig, Germany, a municipal tertiary care center with specialized departments for infectious diseases and tropical medicine, septic surgery, and severe burn injuries, between 1 January 2023 and 31 December 2025. Eight patients (median age 38 years, 75% male) with bloodstream infections, hospital-acquired pneumonia, complex skin and soft tissue infections, and osteomyelitis were identified. Underlying conditions included severe burns, multiple myeloma, and human immunodeficiency virus (HIV) infection. The causative pathogens were carbapenemase-producing Klebsiella pneumoniae (KPC-2, NDM-1, and OXA-48) and carbapenemase-producing Acinetobacter baumannii (OXA-23, OXA-40, OXA-58, and OXA-72), including strains that expressed multiple carbapenemases. The minimum inhibitory concentrations (MICs) for ERV ranged from < 0.12 to 1.0 µg/mL. Five patients received monotherapy with ERV (100 mg twice per day (BID) intravenous (IV)), and three patients received combination therapy at the same dose along with other antimicrobial agents (ceftazidime/avibactam, sulbactam, and gentamicin). The median duration of treatment with ERV was 10 days (range 5–42 days). Clinical cure was achieved in 87.5% of patients (7/8), and all patients—with the exception of one patient with major skin and soft tissue defects and osteomyelitis—showed evidence of microbiological pathogen eradication, apart from extensive burn wounds. ERV at an increased standard dose of 100 mg BID IV was well tolerated, and no adverse events leading to treatment discontinuation were reported. In this small retrospective study presenting preliminary real-world observational data, ERV proved to be a safe and promising treatment option for complex infections caused by carbapenemase-producing Klebsiella pneumoniae and Acinetobacter baumannii strains, characterized by few side effects and good efficacy even outside indications specified in the approval studies.