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Publications

Journal Article Review Ahead of print

PubMed: 42391097 DOI: 10.1080/14787210.2026.2699179

Effectiveness and safety of eravacycline-based regimens for resistant acinetobacter baumannii infections: a systematic review and meta-analysis.

Expert Rev Anti Infect Ther

Authors: Shahd Mohammad, Eman Awwad, Ayah Hajjar, Sulaiman Alzunaydi, Ahmed Ak Al-Hammadi, Thamer A Almangour, Matteo Bassetti

Affiliations

  • Clinical Pharmacy Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
  • Clinical Pharmacy Department, Tawam Hospital, Al Ain, United Arab Emirates.
  • Corporate Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia.
  • Department of Infectious Disease, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
  • Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
  • Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Abstract

INTRODUCTION

Acinetobacter baumannii, particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. This meta-analysis aimed to evaluate the effectiveness and safety of eravacycline versus non - eravacycline-based regimens in adults with resistant A. baumannii infections.

METHODS

MEDLINE, Embase, and Cochrane Central were searched for studies evaluating eravacycline regimens in hospitalized adults with A. baumannii infection. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Data were analyzed using R statistical software.

RESULTS

Fifteen studies encompassing 462 patients were included. Populations consisted predominantly of older adults, with respiratory tract infections representing the most common source of infection (77.6%). Carbapenem-resistant A. baumannii accounted for 84.4% of evaluable cases. No statistically significant differences were observed between eravacycline and non - eravacycline-based regimens in all-cause mortality (RR 1.06; 95% CI 0.46-2.47), clinical cure (RR 0.90; 95% CI 0.77-1.07), or microbiological eradication (RR 0.88; 95% CI 0.56-1.37). Complementary single-arm pooled estimates among eravacycline-treated cohorts were favorable.

CONCLUSION

This meta-analysis strengthens the evidence base for eravacycline effectiveness in resistant A. baumannii infections and supports its consideration when preferred regimens are not feasible; adequately powered randomized trials are needed to define optimal positioning.

MeSH

Safety, Acinetobacter Baumannii, Infections, Acinetobacter