Clinical efficacy and safety of eravacycline for the treatment of enterococcal infections: a subpopulation analysis

Background: Infections due to Enterococcus faecalis and Enterococcus faecium are common in the hospital setting and carry a high risk for morbidity and mortality. Furthermore, the incidence of drug-resistant phenotypes, such as vancomycin-resistant Enterococci (VRE) and daptomycin non-susceptible strains, is increasing. Eravacycline (ERV) is a novel tetracycline antibiotic approved for the treatment of complicated intra-abdominal infections and possesses a broad spectrum of activity across both Gram-positive and Gram-negative organisms, including VRE, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Enterobacterales. Methods: We conducted a subgroup analysis assessing the real-world efficacy and safety of ERV for the treatment of enterococcal infections. Adult patients who received ERV for ≥ 72 h for E. faecalis or E. faecium infections were included. The primary outcome of clinical cure was defined as resolution or improvement of infection-related signs and/or symptoms. Results: A total of 100 patients were included in the analysis. E. faecalis and E. faecium were present in 44% and 58% of patients, respectively, and 49% of all isolates were VRE. The most prevalent infection types were intra-abdominal, skin/soft tissue, and osteomyelitis, and a majority (80%) of infections were polymicrobial. Clinical cure was achieved in 77% of patients. Thirty-day mortality was 17% and 30-day infection-related mortality was 12%. Thirty-day hospital readmission rate was 14%, and microbiological recurrence occurred in 4% of patients. Treatment-emergent adverse events occurred in 8% of patients, with 2% of patients requiring discontinuation of ERV. Conclusion: This study describes the real-world safety and efficacy of ERV for the treatment of enterococcal infections.