Early Experience With Eravacycline for Complicated Infections

Alosaimy, Sara; Molina, Kyle C; Claeys, Kimberly C; Andrade, Justin; Truong, James; King, Madeline; Pullinger, Benjamin; Huang, Glen; Morrisette, Taylor; Lagnf, Abdalhamid M; Davis, Susan L.; Rybak, Michael J.

doi:10.1093/ofid/ofaa071

Cited by 33 publications

(32 citation statements)

References 10 publications

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“…and VRE. Of note, in the Alosaimy et al study [ 23 ], four patients had polymicrobial infections, and CRE was present in all studies.…”

Section: Discussionmentioning

confidence: 95%

“…There have been three previously reported real-world clinical experience studies involving eravacycline [ 20 – 23 ], the largest of which reported on 35 patients. These studies include hospital and OPAT settings.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of patients across all three studies were males, mid-50s in age, with a mean Charlson Comorbidity Index (CCI) of 3, and a large proportion had comorbidities, including diabetes and moderate or severe kidney disease. In two studies, 68.4% [ 21 ] and 89% [ 23 ] of patients had ≥ 1 risk factors for multidrug-resistant organisms based on recent hospitalization and antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Intraabdominal infections comprised 50% > of infections in two studies [ 20 – 22 ] and 34% in the third [ 23 ]; the other predominant infections were respiratory tract infections, bone and joint, bacteremia, and skin and soft tissue infections. All patients in the study by Alosaimy et al [ 23 ] were admitted to the ICU at some stage, demonstrating the complex nature of this patient cohort. The most frequently cultured pathogens from all studies included K. pneumoniae , 4 of which were with CRE, E. coli , Enterobacter cloacae , A. baumannii , E. faecium , MRSA, Enterococcus sp.…”

Section: Discussionmentioning

confidence: 99%

“…Hwang et al [ 21 , 22 ] reported the clinical cure in 63.2% and 5% with improvement. Alosaimy et al [ 23 ] reported 70% clinical success because of persistent signs and symptoms of infection, 22% were considered clinical failure, and, reflective of the critical and complex patient cohort, 12.5% experienced recurrence and 7.5% died. Notably, seven of eight (88%) patients with CRE infections survived, and 91% of patients did not have 30-day recurrence.…”

Section: Discussionmentioning

confidence: 99%

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A Real-World Assessment of Clinical Outcomes and Safety of Eravacycline: A Novel Fluorocycline

et al. 2020

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Background Eravacycline is a novel fluorocycline approved for treatment of intraabdominal infections, with a broad spectrum of activity against a range of pathogens including multidrug-resistant species, including ESBL- or KPC-producing isolates. It is approved for twice-daily dosing with no need for adjustment in renal dysfunction. In the concomitant administration with CYP 3A4-inducing drugs, eravacycline dosing should be modified. Objective To evaluate the efficacy and safety of eravacycline in a range of infections such as intraabdominal infections, pneumonia and diabetic foot infections in seriously ill patients. Methods A retrospective observational cohort study using electronic patient records of 50 consecutive patients administered eravacycline during inpatient acute care admission or as part of outpatient antibiotic therapy (OPAT). Results Therapy of 1.5 mg/kg q24h was initiated in the hospital in most patients, although some of the less sick were managed in the office or OPAT setting. All patients concluded their management outside of the hospital. Of the 50 patients, 47 (94%) achieved clinical resolution of their infection and 3 (6%) clinical failures occurred. Only three (6%) patients did not have comorbidities, three had a single comorbidity (6%), and the majority (88%) of patients had two or more comorbidities. Most common infections were intraabdominal (36%), pneumonia (18%), diabetic foot (12%), spontaneous bacterial peritonitis (8%) and empyema (8%). Almost half of infections had more than one pathogen isolated, and resistant isolates were frequent. The drug was well tolerated with only two reports of nausea, which did not result in treatment discontinuation, and in 30 days of post-eravacycline therapy only one case of Clostridiodes difficile . Conclusions In this real-world setting, eravacycline demonstrated a similar high level of clinical efficacy as seen in clinical trials, 94%, in a variety of infections, including against multidrug-resistant bacteria, and was well tolerated.

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“…and VRE. Of note, in the Alosaimy et al study [ 23 ], four patients had polymicrobial infections, and CRE was present in all studies.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Real-World Assessment of Clinical Outcomes and Safety of Eravacycline: A Novel Fluorocycline

et al. 2020

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Gram-Negative Infection

Tatara

2023

The Infectious Diseases Consult Handbook

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Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

2020

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The management of carbapenem-resistant infections is often based on polymyxins, tigecycline, aminoglycosides and their combinations. However, in a recent systematic review, we found that Gram-negative bacteria (GNB) co-resistant to carbapanems, aminoglycosides, polymyxins and tigecycline (CAPT-resistant) are increasingly being reported worldwide. Clinical data to guide the treatment of CAPT-resistant GNB are scarce and based exclusively on few case reports and small case series, but seem to indicate that appropriate (in vitro active) antimicrobial regimens, including newer antibiotics and synergistic combinations, may be associated with lower mortality. In this review, we consolidate the available literature to inform clinicians dealing with CAPT-resistant GNB about treatment options by considering the mechanisms of resistance to carbapenems. In combination with rapid diagnostic methods that allow fast detection of carbapenemase production, the approach proposed in this review may guide a timely and targeted treatment of patients with infections by CAPT-resistant GNB. Specifically, we focus on the three most problematic species, namely Klebsiella pneumoniae , Pseudomonas aeruginosa and Acinetobacter baumannii . Several treatment options are currently available for CAPT-resistant K. pneumonia . Newer β-lactam-β-lactamase combinations, including the combination of ceftazidime/avibactam with aztreonam against metallo-β-lactamase-producing isolates, appear to be more effective compared to combinations of older agents. Options for P. aeruginosa (especially metallo-β-lactamase-producing strains) and A. baumannii remain limited. Synergistic combination of older agents (e.g., polymyxin- or fosfomycin-based synergistic combinations) may represent a last resort option, but their use against CAPT-resistant GNB requires further study.

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Early Experience With Eravacycline for Complicated Infections

Cited by 33 publications

References 10 publications

A Real-World Assessment of Clinical Outcomes and Safety of Eravacycline: A Novel Fluorocycline

A Real-World Assessment of Clinical Outcomes and Safety of Eravacycline: A Novel Fluorocycline

Gram-Negative Infection

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

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