Retrospective analysis of the efficacy and safety of omadacycline in the treatment of pulmonary infections

The overall clinical response rate was 80.4% (86/107), and the microbiological eradication rate was 62.5% (15/24). Targeted therapy was administered in 52 patients, among whom 24 had multidrug-resistant bacterial infections. The efficacy of monotherapy was significantly higher than that of combination therapy (58.1% vs. 41.9%, P=0.001), and there was no statistically significant difference in efficacy among different classes of combined anti-infective agents (P>0.05).

Significant differences were detected in body temperature, white blood cell count, neutrophil percentage, C-reactive protein and procalcitonin between pre-treatment and post-treatment in all patients and the clinical response group (P<0.05). Hepatic injury occurred in 4 cases (5.2%), acute kidney injury (AKI) in 1 case (1.4%), decreased prothrombin time in 31 cases (64.6%), decreased D-dimer in 22 cases (59.5%), and decreased fibrinogen in 32 cases (66.7%).

Multivariate logistic regression analysis demonstrated that age, APACHE II score, SOFA score, ICU admission, endotracheal intubation, continuous renal replacement therapy, targeted therapy, combination therapy and multidrug-resistant bacterial infections were risk factors for omadacycline treatment failure. In contrast, hypofibrinogenemia, on-label drug use and non-severe community-acquired pneumonia were protective factors for favorable clinical outcomes with omadacycline.Conclusion In clinical practice, omadacycline should be administered in accordance with its approved indications, and combination therapy is not recommended.

Close monitoring of liver function and fibrinogen levels were warranted during treatment.