Outcomes of adjunctive eravacycline for severe and fulminant Clostridioides difficile infection

To characterize eravacycline (ERV) treatment for severe or fulminant Clostridioides difficile infection (CDI) and describe patient outcomes.

This was an institutional review board-approved, cross-sectional study of hospitalized adult patients with CDI who received adjunctive ERV with standard-of-care antibiotics for CDI from January 2019 to December 2023 at a five-hospital health system. Patients were included if they received ERV with standard-of-care antibiotics for ≥24 hours for severe or fulminant CDI. Patients with a history colectomy or with non-CDI ERV indications were excluded. The primary outcome was the proportion of patients that required colectomy due to C. difficile; secondary outcome was all-cause mortality at 30 days.

Seventy-five patients were included: 25 (33%) had severe and 50 (67%) fulminant CDI and 23 (31%) had refractory severe/fulminant CDI. Patients receiving ERV were frequently immunocompromised (30, 40%) and required treatment in an intensive care unit (46, 61%). Eleven (14.7%) patients required colectomy within 30 days of adjunctive ERV; 28 (37%) patients died at 30-days.

ERV may be useful as a potential adjunctive therapy for severe or fulminant CDI. Patients receiving ERV often were immunocompromised and had fulminant disease with critical illness. Future comparative studies are needed to evaluate the impact of adjunctive ERV for CDI.