Objective To evaluate the efficacy and safety of eravacycline in the treatment of pulmonary infections based on real-world data.

Methods This multicenter retrospective cohort study enrolled patients with pulmonary infections who received eravacycline treatment across 21 provinces/cities in China from September 2023 to September 2024. Pathogen spectrum characteristics, clinical and microbiological efficacy, patient outcomes, and medication safety were analyzed. Differences in efficacy were compared between mono-infection and co-infection cases, as well as between eravacycline monotherapy and combination therapy.

Results A total of 2859 patients with pulmonary infections receiving eravacycline were enrolled. Patients were primarily from intensive care units (48.6%). Among patients with identified pathogens, mono-infection was the predominant type (91.0%, 2029/2230), while co-infections were less common (9.0%, 201/2230). The main pathogens in the mono-infection group were Acinetobacter baumannii (55.0%) and Klebsiella pneumoniae (25.8%). The eravacycline monotherapy group comprised 1218 patients (42.6%), and the combination therapy group comprised 1641 patients (57.4%). Most 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 efficacy rate was 89.7% (2565/2859), and the microbiological efficacy rate was 90.2% (2580/2859). At the 30-day follow-up post-treatment, the rate of patients discharged with improvement was 82.7% (2365/2859), and the all-cause mortality rate was 12.1% (347/2859). At the end of eravacycline treatment, the mono-infection group showed significantly higher clinical efficacy (90.5% vs. 83.1%, P=0.001), microbiological efficacy (91.0% vs. 83.1%, P < 0.001), and rate of discharge with improvement at the 30-day follow-up (83.2% vs. 74.1%, P=0.001) compared to the co-infection group. No significant differences were observed between the monotherapy and combination therapy groups in clinical efficacy, microbiological efficacy at treatment end, or patient outcomes at the 30-day follow-up (all P > 0.05). During treatment, 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.

Conclusion Eravacycline demonstrates high clinical and microbiological efficacy in treating pulmonary infections, with a favorable safety profile and mild adverse reactions.