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Evaluation of Incidence of and Potential Risk Factors for Bloodstream Infections in REVEAL Patients with Pulmonary Arterial Hypertension Receiving Intravenous Prostacyclin or Prostacyclin Analogs

Natalie Kitterman

Abby Poms


Sandra Lombardi


D. Miller

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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

N. Kitterman, BSN, RN, CCRP1; A. Poms, BS, RRT2; S. Lombardi, RN3; D. Miller, MS4
1. Intermountain Medical Center, Salt Lake City, UT
2. Duke University School of Medicine, Durham, NC
3. University of California, San Diego, San Diego, CA
4. ICON Late Stage & Outcomes Research, San Francisco, CA

PURPOSE: The Registry to Evaluate Early And Long-term Pulmonary Arterial Hypertension (PAH) Disease Management (REVEAL) collects data prospectively on confirmed blood stream infections (BSIs) in patients receiving intravenous (IV) prostacyclin (epoprostenol) or prostacyclin analog (treprostinil). We explored the characteristics of BSIs reported in REVEAL from time of enrollment.

METHODS: REVEAL patients who were receiving continuous IV prostanoids at enrollment or those initiated on prostanoids in the registry were included if they had ≥1 IV prostanoid exposure day from enrollment to 20 September 2010. Infections were classified as gram positive (gram+) or gram negative (gram-) with or without co-infection. P-value calculations used chi-square test for categorical data, t-test for continuous data, and Poisson regression for infection rates.

RESULTS: Of 3,518 patients enrolled in REVEAL, 1,146 had at least one day of IV prostanoid exposure during the study period and 123 had ≥1 BSI. Twenty-nine (24%) of these patients developed ≥2 BSIs during the course of REVEAL follow-up for a total of 166 BSIs reported over 832,881 patient-days of risk. BSI incidence was not dependent upon Group I PAH subgroup or disease severity. Overall BSI rate was 20 per 100,000 patient-days of risk: 11.9 per 100,000 patient-days of risk for IV epoprostenol vs. 35.7 per 100,000 patient-days of risk for IV treprostinil (P<0.001), with most of the difference in rates due to gram- infections (3.1 per 100,000 patient-days of risk vs. 19.6 per 100,000 patient-days of risk, respectively; P<0.001). The rate of gram+ infections was 6.2 per 100,000 patient-days of risk and 11.8 per 100,000 patient-days of risk, respectively (P=0.018). Prostanoid concentration, pump type, catheter type, and year BSI(s) occurred were unrelated to infection type. There was a temporal trend towards a decrease in the overall infection rate from 2007 to 2009, though there were significantly more gram- BSIs in patients on IV treprostinil each year (P≤0.001 for each year). There were no significant differences in the rate of gram+ infections by year.

CONCLUSION: There was an overall low BSI rate of 20 per 100,000 patient-days of risk for REVEAL patients. However, the rate of BSIs in patients receiving IV treprostinil was 3 times that of patients receiving IV epoprostenol. When comparing BSI organisms there was a 6.3-fold increase in gram- infections and 2 times more gram+ infections in patients receiving IV treprostinil vs. IV epoprostenol, respectively. Further investigation of these differences is paramount to improving patient morbidity, mortality, and quality of life.