Eravacycline in sepsis complicated by Clostridioides difficile infection: a brief case series

Clostridioides difficile infection complicating severe bacterial infections presents a therapeutic challenge, when antimicrobial discontinuation is unfeasible. Eravacycline, a synthetic fluorocycline with broad-spectrum activity against Gram-positive, Gram-negative and anaerobic bacteria, including C. difficile, carries a relatively low risk of inducing C. difficile. Although approved for complicated intra-abdominal infections, emerging evidence indicates its potential for other severe infections. We report three cases of C. difficile infection during systemic antibacterial therapy for severe infections complicated by sepsis. In all cases, antibiotics could not be discontinued due to uncontrolled infection. Switching to intravenous eravacycline, alongside C. difficile-directed therapy, allowed clinical improvement of the underlying infection and resolution of diarrhea, with no eravacycline-related adverse events. Two patients survived to discharge without recurrence at 90-day follow-up, whereas one patient died from unrelated complications. This limited experience indicates that eravacycline might be a microbiome-sparing stewardship option in selected severe infections complicated by C. difficile infection.