Juan Chen,1– 3 Xingxian Qian,2 Bingqing Yue,3,4 Huiru Lin,1– 3 Shuo Ding,1– 3 Jingyu Chen,3– 5 Man Huang1– 3 

1Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Key Laboratory of Multiple Organ Failure, Zhejiang University, Ministry of Education, Hangzhou, Zhejiang, People’s Republic of China; 3Lung Transplantation Laboratory of The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Lung Transplantation, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 5Wuxi Lung Transplant Center, Wuxi People’s Hospital affiliated to Nanjing Medical University, Wuxi, Jiangsu, People’s Republic of China

Correspondence: Man Huang, Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, 1511 Jianghong Road, Hangzhou, Zhejiang, 310009, People’s Republic of China, Tel +8657189713427, Email huangman@zju.edu.cn Jingyu Chen, Department of Lung Transplantation, The Second Affiliated Hospital of Zhejiang University School of Medicine, 1511 Jianghong Road, Hangzhou, Zhejiang, 310009, People’s Republic of China, Email chenjy9611@zju.edu.cn

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections were associated with higher mortality and significant healthcare burden. Novel antibiotics provided a powerful weapon against CRAB. This study aimed to describe the effectiveness of eravacycline for the treatment of CRAB infections in lung transplant recipients.
Methods: This was a single-center, retrospective study that enrolled lung transplant recipients with CRAB infections who received eravacycline for over 72 hours between August 2023 and December 2024. The primary outcome was 28-day survival rate. Secondary outcomes included 14-day survival and clinical failure rate.
Results: A total of 24 lung transplant recipients were enrolled, with a median age of 60.5 years and a predominance of male patients. Nearly half had interstitial lung disease as the primary pulmonary condition. These recipients in our study mainly had pulmonary infections attacked by CRAB, with six individuals suffering septic shock. The median duration of eravacycline therapy was 10 days, with most patients receiving combination therapy. The primary outcome, the 28-day survival rate, was 83.3%, while the secondary outcomes showed a 14-day survival rate of 100% and a clinical failure rate of 37.5%. The median ICU and hospital lengths of stay were 12.5 and 55 days, respectively. A comparison between patients with and without clinical failure showed that those with clinical failure were older, had a higher incidence of septic shock, a higher proportion of continuous renal replacement therapy, and a longer ICU stays. Additionally, these patients exhibited an elevated heart rate, higher levels of ALT and AST, lower protein levels (total protein, albumin), prolonged PT and APTT, and increased level of CRP and PCT at the end of treatment.
Conclusion: This study presented the clinical efficacy of eravacycline in lung transplant recipients with CRAB infections, providing valuable evidence and clinical experience for its use in organ transplant populations.

Keywords: carbapenem-resistant Acinetobacter baumannii, eravacycline, lung transplantation, effectiveness