Adjunctive Eravacycline May Be Effective for Patients With C difficile Infection

Adjunctive eravacyline therapy may be effective among patients hospitalized with severe, recurrent, or fulminant Clostridioides difficile infection (CDI). These study findings were presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Researchers conducted a retrospective case series to evaluate the effects of adjunctive eravacycline for the management of adult patients hospitalized with CDI. Eravacycline is a fluorocycline that has shown in vitro activity against CDI. Included patients were those who received adjunctive eravacycline for at least 24 hours for the treatment of severe, recurrent, or fulminant CDI between September 2019 and February 2020. The primary outcome was all-cause mortality at 30 days following treatment initiation; secondary outcomes were the rate of clinical cure, CDI recurrence within 30 days, and the need to undergo colectomy. The researchers used descriptive statistics and central tendency measurements to report outcome data.

There were a total of 14 patients included in the analysis, of whom 4 had severe, 4 had recurrent, and 6 had fulminant CDI. Among all patients, the mean age was 63 years, 5 were men, 7 were immunocompromised, and 8 required intensive care unit admission. All 6 patients with fulminant CDI had hospital-acquired infection.

At treatment initiation, 8 patients were receiving eravacycline plus oral vancomycin, and 6 were receiving combination therapy with eravacycline, intravenous metronidazole, and oral vancomycin. The median duration of eravacycline therapy was 6 days.

In-hospital 30-day all-cause mortality occurred in 2 patients, both of whom had fulminant CDI. Clinical cure was achieved by 12 patients, including 4 (100%) with severe, 4 (100%) with recurrent, and 4 (66.7%) with fulminant CDI. Of the 2 (14%) patients who required colectomy, 1 underwent the procedure on the same day as CDI diagnosis and eravacycline initiation, and 1 underwent the procedure 4 days prior to eravacycline initiation.

Two patients with recurrent CDI underwent fecal microbiota transplantation in an outpatient setting, of whom 1 received bezlotoxumab. There was 1 patient who required hospital readmission within 30 days, and no patients had CDI recurrence.

According to the researchers, “Prospective studies are needed to further investigate the safety and efficacy of ERV [eravacycline] in serious CDI.”