Abstract: Objective: To evaluate the efficacy and safety of eravacycline in the treatment of pulmonary infections based on real-world data. Methods: This multicenter,observational study enrolled patients with pulmonary infections who received eravacycline treatment from September 2023 to September 2024 across 21 provinces in China.The analysis included pathogen profile characteristics,clinical and microbiological efficacy,patient outcomes,and drug safety,with comparisons made between monomicrobial and polymicrobial infections,as well as between monotherapy and combination therapy. Results: A total of 2859 patients with pulmonary infections treated with eravacycline were included.The majority of patients were from the intensive care unit (48.6%).Among patients with clearly identified pathogens,monomicrobial infection was the predominant type (91.0%,2029/2230),while polymicrobial infection was less common (9.0%,201/2230).The main pathogens in the monomicrobial infection group were Acinetobacter baumannii (55.0%) and Klebsiella pneumoniae (25.8%).There were 1218 patients (42.6%) in the eravacycline monotherapy group and 1641 patients (57.4%) in the combination therapy group.The majority of patients (94.4%,2699/2859) received the standard dose (1 mg/kg every 12 hours),with a mean treatment duration of 9.0 days.At the end of eravacycline treatment,the overall clinical response rate was 89.7%(2565/2859),and the microbiological eradication rate was 90.2%(2580/2859).At the 30-day follow-up after treatment completion,the rate of improvement and discharge was 82.7%(2365/2859),and the all-cause mortality rate was 12.1%(347/2859).In the monomicrobial infection group,the clinical response rate (90.5% vs.83.1%,P=0.001),microbiological eradication rate (91.0% vs.83.1%,P<0.001),and the rate of improvement and discharge at the 30-day follow-up (83.2% vs.74.1%,P=0.001) were all significantly higher than those in the polymicrobial infection group.No significant differences were observed in the clinical response rate,microbiological eradication rate at the end of treatment,or patient outcomes at the 30-day follow-up between the monotherapy and combination therapy groups (P>0.05).During the treatment period,the incidence of drug-related adverse events was 2.4%(69/2859),primarily mild gastrointestinal reactions (0.9%,27/2859),with only one case (0.03%) of severe liver injury reported. Conclusion: Eravacycline demonstrates high clinical and microbiological efficacy in the treatment of pulmonary infections,with a favorable safety profile characterized by mild adverse reactions.