633. Eravacycline Use in Immunocompromised Patients: Multicenter Evaluation of Clinical and Safety Endpoints
Authors: Kunz Coyne Ashlan J , Allosaimy Sara , Molina Kyle C , Kang-Birken Lena , Lagnf Abdalhamid M , Claeys Kimberly C , Veve Michael , King Madeline , Pullinger Benjamin , Bouchard Jeannette , Gore Tristan , Rojas Leonar , Tart Serina , Hobbs Athena L V , Perkins Nicholas , Biagi Mark , Pierce Michael , Cosimi Reese , Jones Bruce M , Truong James , Andrade Justin , Huang Glen , Lucas Kristen , Morrisette Taylor , Holger Dana , Rebold Nicholas S , Ghali Amer El , Ghali Amer El , Davis Susan L , Rybak Michael J 
Published: December 2022

Abstract

Background
Infections caused by multidrug-resistant (MDR) bacteria are an increasingly common public health threat associated with worse outcomes in immunocompromised patients. Eravacycline (ERV) has potent in-vitro activity against MDR Gram-negative and Gram-positive bacteria and has demonstrated non-inferiority to meropenem in the phase III IGNITE4 trial; however, the trial excluded immunocompromised patients. We aimed to evaluate clinical and safety endpoints of immunocompromised patients receiving ERV as definitive therapy.

Methods
Multicenter, retrospective, observational study conducted from October 2018 to April 2022. Adult hospitalized immunocompromised patients treated with ERV for ≥72 hours were included. Immunocompromised patients were defined as having any of the following: chemo or radiation therapy &lt; 30 days of hospital admission, HIV/AIDS with CD4 &lt; 200, chronic steroids ( &gt;40 mg prednisone or equivalent. The primary outcome was 30-day survival. Secondary outcomes were lack of 30-day infection recurrence and drug-related safety events.

Results
Overall, 75 immunocompromised patients treated with ERV were included from 17 United States medical centers. Median (IQR) age was 62 (53-70) and 61.6% were male. Hospital length of stay was 28 (13-42) days and 67% were admitted to the intensive care unit. SOFA and APACHE II scores were 3.5 (1-7) and 16 (11-20), respectively. Common infection sources were intra-abdominal (26%) and lower respiratory tract (18%); 24% were bacteremic. Most patients had cultured Enterobacterales (58.7%) and Enterococci (37%) spp. infections. Of those, 21.3% were CRE and 19% were VRE. Infectious diseases consult was obtained in 91.8% of cases. Time elapsed from index culture collection to ERV initiation was 4 (2-8) days and duration of ERV therapy was 7 (4-12) days. In total, 81.3% of immunocompromised patients achieved 30-day survival and 90.7% did not have 30-day infection recurrence. Probable drug-related adverse events occurred in 5.3% of patients (GI 4%, rash 1%).

Conclusion
A majority of immunocompromised patients receiving ERV as definitive therapy achieved 30-day survival and did not experience infection recurrence. ERV use in immunocompromised subpopulations will benefit from studies tailored to their specific characteristics.

Disclosures
Kimberly C. Claeys, PharmD, BioFire Diagnostics: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.