A Retrospective Case-Control Study of Eravacycline for the Treatment of Carbapenem-Resistant Acinetobacter Infections in Patients With Burn Injuries

Abstract

Thermal injuries lead to a deficiency in one’s natural, protective barrier, resulting in increased susceptibility to pathogens, and often require multiple courses of broad-spectrum antibiotics. Eravacycline has shown adequate in vitro activity against multiple MDR pathogens including Acinetobacter sp. Due to the increasing prevalence of multi-drug resistant bacteria and the heightened susceptibility of burn patients to infection, studies are needed to examine the clinical effect of eravacycline in this population. The objective of this retrospective, case-control study was to compare the outcomes of patients with thermal injuries treated with eravacycline versus a matched control for Carbapenem-resistant Acinetobacter baumannii (CRAB) infections. Patients with thermal injury admitted to an American Burn Associated-verified burn center from May 1, 2019 to July 31, 2022, who received eravacycline, were randomly matched 4:1 to a historical cohort, using a previously established, de-identified dataset of patients treated with colistimethate (CMS) in the same burn center (March 1, 2009 to March 31, 2014), based on %TBSA, age, and CRAB. A composite favorable outcome was defined as 30-day survival, completion of course, lack of 14-day recurrence, and lack of acute kidney injury. Treatment with eravacycline over CMS was not more or less likely to be associated with a favorable response [odds ratio (95% confidence interval), 2.066 (0.456 – 9.361), p = 0.347]. Patients treated with CMS had a nearly 9-fold higher odds of new onset AKI vs ERA [8.816 (0.911 - 85.308), p = 0.06]. Adverse events were uncommon in the ERA group. There was no difference in mortality.

Treatment Strategies of Colistin Resistance Acinetobacter baumannii Infections

“…• Breakpoints not established • Very limited clinical evidence, predominantly from small case series and small observational studies [83][84][85][86] and potentially poor outcomes in bloodstream infections [83] Fosfomycin A. baumannii is considered inherently resistant to fosfomycin. However, fosfomycin can be useful as part of synergistic combination regimens based on in vitro data, as well as limited clinical data [7,[87][88][89][90].…”