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.