2026 Southeastern Residency Conference

Purpose: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a high-priority antibiotic-resistant pathogen of public health concern and is associated with substantial morbidity and mortality. In 2024, the Infectious Disease Society of America (IDSA) recommended sulbactam-durlobactam in combination with a carbapenem as the preferred regimen for the treatment of CRAB. Despite IDSA recommendations, there isn’t a standard of care regimen for CRAB. Eravacycline, a synthetic fluorocycline, demonstrates structural resilience against common resistance mechanisms and shows in vitro activity against CRAB. This study aims to evaluate the clinical effectiveness of eravacycline-based therapy compared with best available therapy (BAT) in hospitalized patients with CRAB.
Methods: A retrospective chart review was performed on patients admitted to FMOL Health- Our Lady of the Lake with CRAB infections between January 2020 to December 2025. Patients aged 18 years and older with a documented infection of CRAB who receive one or more doses of eravacycline-based therapy or BAT were included. Patients were excluded if they were pregnant, did not receive antimicrobial treatment, discharged within 48 hours of admission, transferred to another hospital, or died prior to initiating antimicrobials. The primary outcome is a desirability of outcome ranking (DOOR) comparing eravacycline to BAT for treatment of infections caused by CRAB. The rankings are defined as the following: (1) clinical success without infectious complications or adverse events, (2) clinical success with infectious complications or adverse events, (3) absence of clinical success without infectious complications or adverse events, (4) absence of clinical success with infectious complications or adverse effects, and (5) death. Secondary outcomes include length of stay, duration of therapy, and relapse infection.
Results: A total of 271 patients were screened for eligibility. Of those evaluated, 96 patients were included in this study: 42 patients in the eravacycline group and 54 patients in the BAT group. The majority of patients were male (66.7%), black or African American race (51.04%), and had a median age of 60 years old. Most patients had at least one hospitalization in the 90 days prior to index hospitalization (65.6%) and had received IV antibiotics at least 90 days prior (60.4%). There was no significant difference between groups between any DOOR scale. The median length of hospital stay was 29.94 days, and the average length of therapy was 13.18 days. Repeat CRAB cultures were seen in 35.71% and 27.78% of patients in the eravacycline group and BAT group, respectively.
Conclusion: Among patients with CRAB, eravacycline did not appear to improve clinical outcomes or affect DOOR distribution.