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Antibiotics
Volume 15
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10.3390/antibiotics15010093
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Case Report

Eravacycline as Salvage Therapy for Severe Intra-Abdominal Infections Caused by Multidrug-Resistant Acinetobacter baumannii: A Case Series

by
Marcello Trizzino
1,†,
Giulio D’Agati
1,2,†,
Luca Pipitò
1,2,*,
Claudia Conti
1,2,
Rossella Petrantoni
1,
Raffaella Rubino
1,
Antonio Anastasia
1,
Sofia Urso
1,2,
Irene Ganci
1,2,
Maria Cappello
3 and
Antonio Cascio
1,2,*
1
Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90133 Palermo, Italy
2
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90133 Palermo, Italy
3
Gastroenterology & Hepatology, AOUP “P. Giaccone”, Università di Palermo, 90127 Palermo, Italy
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Antibiotics 2026, 15(1), 93; https://doi.org/10.3390/antibiotics15010093
Submission received: 21 December 2025 / Revised: 12 January 2026 / Accepted: 15 January 2026 / Published: 16 January 2026
(This article belongs to the Special Issue Carbapenem-Resistant Acinetobacter baumannii: From Molecular Mechanisms to Clinical Practice)
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Abstract

Background/Objectives: Infections due to multidrug-resistant (MDR) Acinetobacter baumannii represent a critical challenge in modern healthcare, with limited therapeutic options. Eravacycline, a novel fluorocycline antibiotic, demonstrates promising in vitro activity, but real-world clinical data for complex intra-abdominal infections (IAIs) are scarce. We present two cases of severe IAI caused by carbapenem-resistant A. baumannii (CRAB) successfully treated with eravacycline. Methods: We describe the clinical course, microbiological findings, and outcomes of two critically ill patients. Case 1 was a 75-year-old male with biliary peritonitis following an endoscopic procedure. Case 2 was a 64-year-old male with infected pancreatic walled-off necrosis. Both patients had cultures positive for CRAB and failed multiple prior antibiotic regimens. Results: In both cases, the initiation of intravenous eravacycline led to significant clinical improvement, including resolution of septic shock and defervescence. A marked reduction in inflammatory markers (C-reactive protein and procalcitonin) was observed, alongside microbiological clearance of CRAB. Eravacycline was well tolerated, with no significant adverse events. Conclusions: These case reports suggest that eravacycline can be an effective and safe salvage therapy for complex IAIs caused by CRAB, even in scenarios of partial source control. It represents a valuable addition to the antimicrobial armamentarium for managing infections caused by these extensively drug-resistant organisms.
Keywords: eravacycline; Acinetobacter baumannii; multidrug-resistant; intra-abdominal infection; carbapenem-resistant; case report eravacycline; Acinetobacter baumannii; multidrug-resistant; intra-abdominal infection; carbapenem-resistant; case report

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MDPI and ACS Style

Trizzino, M.; D’Agati, G.; Pipitò, L.; Conti, C.; Petrantoni, R.; Rubino, R.; Anastasia, A.; Urso, S.; Ganci, I.; Cappello, M.; et al. Eravacycline as Salvage Therapy for Severe Intra-Abdominal Infections Caused by Multidrug-Resistant Acinetobacter baumannii: A Case Series. Antibiotics 2026, 15, 93. https://doi.org/10.3390/antibiotics15010093

AMA Style

Trizzino M, D’Agati G, Pipitò L, Conti C, Petrantoni R, Rubino R, Anastasia A, Urso S, Ganci I, Cappello M, et al. Eravacycline as Salvage Therapy for Severe Intra-Abdominal Infections Caused by Multidrug-Resistant Acinetobacter baumannii: A Case Series. Antibiotics. 2026; 15(1):93. https://doi.org/10.3390/antibiotics15010093

Chicago/Turabian Style

Trizzino, Marcello, Giulio D’Agati, Luca Pipitò, Claudia Conti, Rossella Petrantoni, Raffaella Rubino, Antonio Anastasia, Sofia Urso, Irene Ganci, Maria Cappello, and et al. 2026. "Eravacycline as Salvage Therapy for Severe Intra-Abdominal Infections Caused by Multidrug-Resistant Acinetobacter baumannii: A Case Series" Antibiotics 15, no. 1: 93. https://doi.org/10.3390/antibiotics15010093

APA Style

Trizzino, M., D’Agati, G., Pipitò, L., Conti, C., Petrantoni, R., Rubino, R., Anastasia, A., Urso, S., Ganci, I., Cappello, M., & Cascio, A. (2026). Eravacycline as Salvage Therapy for Severe Intra-Abdominal Infections Caused by Multidrug-Resistant Acinetobacter baumannii: A Case Series. Antibiotics, 15(1), 93. https://doi.org/10.3390/antibiotics15010093

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