Abstract Background Eravacycline (ERV), a novel fluorocycline antibiotic, has demonstrated significant activity against carbapenem-resistant organisms (CRO) such as Enterobacterales. Lung transplant recipients (LTRs) face much higher mortality from multidrug-resistant (MDR) infections than general population, yet treatment options are limited. ERV might offer a potential treatment option, while the related data is limited. This retrospective cohort study evaluated the efficacy and safety of eravacycline (ERV) in treating pulmonary multidrug-resistant (MDR) bacterial infections in LTRs. Methods This was a retrospective study based on clinical data and electronic healthcare records. Forty LTRs who were treated with ERV at First Affiliated Hospital of Guangzhou Medical University between October 2023 and May 2025 were included. Demographic characteristics, clinical parameters, laboratory values, treatment regimens, and outcomes were systematically extracted using standardized data collection forms. Primary outcomes included clinical effectiveness, microbiological clearance, and comprehensive effectiveness, with secondary outcomes focusing on safety. Results The clinical effectiveness rate was 85.0%, with 60.0% achieving both clinical and microbiological success. Microbiological eradication occurred in 51.6% of evaluable cases. Pathogen-specific analysis showed strong efficacy against several CROs, with the most frequently isolated being Klebsiella pneumoniae (82.8%), Acinetobacter baumannii (81.3%), and Stenotrophomonas maltophilia (85.7%), respectively. The overall condition of the patients improved significantly after therapy. ERV’s safety profile was favorable, with only 10% of patients experiencing mild gastrointestinal side effects and no severe toxicities. Laboratory parameters showed significant improvements in white blood cell count and neutrophil percentage following treatment. No significant differences in outcomes were observed between first-line and second-line treatments. Predictive models for treatment outcomes further emphasized ERV’s clinical utility in managing infections in lung transplant recipients. Conclusions This study highlighted ERV’s potential as an effective treatment for MDR pulmonary infections in immunocompromised patients, with a favorable safety profile. These findings support further investigation into ERV’s role in managing pulmonary infections caused by CRO, potentially expanding its clinical indications. This abstract is funded by: None
Xu et al. (Fri,) studied this question.