Efficacy, safety, and population pharmacokinetics of eravacycline for carbapenem-resistant organism infections in immunocompromised hosts: A multicenter prospective cohort study

OBJECTIVES: We aimed to evaluate the effectiveness, safety, and pharmacokinetics of eravacycline in treating carbapenem-resistant organism (CRO) infections in immunocompromised hosts (ICHs). METHODS: A prospective study was conducted at five hospitals in China from January 2024 to July 2025. Patients with confirmed CRO infections who received intravenous eravacycline at a fixed, consecutive dose of 50 mg for at least 72 hours were included. Plasma concentrations were measured, and pharmacokinetic modeling was performed. RESULTS: Microbiological clearance rates differed by infection site: intra-abdominal infections showed the highest clearance (80.6%, 50/62) and pulmonary infections the lowest (32.4%, 23/71), compared with the overall cohort clearance rate of 51.4% (91/177) (P < 0.001). The 28-day mortality rate was 35.6%. PPK modeling (one-compartment), based on plasma concentration data from 80 patients (54 transplant and 26 non-transplant), revealed reduced clearance in non-transplant patients with cirrhosis, with 45.7% lower clearance in Child-Pugh B and 86.3% lower clearance in Child-Pugh C. In transplant recipients, body weight (BW) exhibited a significant linear association with clearance, while the C-reactive protein level was inversely correlated with distribution volume, while moderate CYP3A4/5 inhibitor use increased the volume by 38.9%. Adverse events occurred in 13.6% of patients. Multivariable analysis identified older age and fungal co-infection as factors associated with mortality. A treatment duration of ≥5 days was associated with improved survival. CONCLUSIONS: Eravacycline monotherapy can achieve favorable outcomes in ICHs with CRO infections and help in managing future CRO infections.