Clinical Outcomes of Eravacycline in Patients Treated for Stenotrophomonas maltophilia Infections.

Introduction: Stenotrophomonas maltophilia is notable for its rising incidence and multidrug resistance, which complicates treatment. As a result of insufficient clinical studies, the 2024 Infectious Diseases Society of America (IDSA) Guidance on Treating Antimicrobial Resistant Gram-negative Infection advises against using eravacycline (ERV) for S. maltophilia infections. We present real-world data on patients treated with ERV for these infections.

Methods: This multicenter, retrospective, observational study included adult patients who received ERV for treating S. maltophilia infections for ≥ 72 h between October 2018 and August 2022. The primary outcome was the clinical cure evaluated at the end of ERV therapy. Key secondary outcomes included a 30-day survival rate, absence of infection recurrence counting from the end of ERV therapy, and occurrence of possible ERV-related adverse effects (AE) noted in the patient's records.

Results: Overall, 41 patients were included with a median (interquartile range [IQR]) age of 63 years (46.0-74.5). Most patients were male (63.4%) and white (51.2%). The primary source of infection was pulmonary (56.1%), and most patients received ERV for regimen consolidation (65.9%). Combination therapy was used in about 10% of the cases for S. maltophilia treatment. The median (IQR) duration of ERV treatment was 7 days (4.0-11.5). The clinical cure rate was 73.2%, and the 30-day survival rate was 68.3%. Four patients (9.8%) experienced possible AE from ERV.

Conclusion: S. maltophilia infections are challenging to treat because of limited options. An analysis of 41 patients indicates ERV may be an acceptable treatment option, but more clinical studies are needed to evaluate its efficacy and safety.