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Incidence of Bloodstream Infections in Patients with Pulmonary Arterial Hypertension Treated with Intravenous Prostacyclin Therapy

M. A. Crist

Kristy Bauer

Namita Sood

J. A. Bazan

Laura Duvall


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Crist MA, Bauer KA, Sood N, Bazan JA, Duvall LA

Wexner Medical Center at the Ohio State University, Columbus, Ohio, USA

BACKGROUNDPulmonary arterial hypertension (PAH) is a serious lung disease characterized by increased pulmonary artery pressure and vascular resistance. Intravenous (IV) prostacyclin therapy has been shown to improve survival in patients with PAH. Epoprostenol and treprostinil are two IV prostacyclin medications that are currently available. Both agents require continuous administration via central venous catheter (CVC). Studies suggest the overall incidence of central line-associated bloodstream infections (CLABSIs) to be 0.26 and 0.55 cases per 1000 treatment days.

The primary objective of this study is to determine the incidence of CLABSI in PAH patients receiving prostacyclin therapy. Secondary objectives include the identification of risk factors, incidence of relapse and reinfection, infection related length of hospital stay (LOS), and 28-day all-cause mortality.

METHODSThis retrospective, single-center study evaluated PAH patients receiving either epoprostenol or treprostinil from January 1, 1998 to August 31, 2011. Patients <18 or >89 years of age, prisoners, and patients who received both epoprostenol and treprostinil were excluded. All P-values were determined by χ2, t-test, Fishers exact, Wilcoxon rank sum tests, as appropriate. 0.05 was considered statistically significant. Data are presented as median (interquartile range). Univariate and multivariate hazard models were performed to determine risk factors associated with the development of infection.

RESULTSA total of 161 patients were included in the study. Overall incidence of CLABSI was 0.45 cases per 1,000 treatment-days, with a lower incidence noted in patients who received epoprostenol compared to treprostinil (0.42 vs. 0.52 per 1,000 treatment-days, P= 0.5510). Time to first infection after line placement in all patients was 88 days (11-243 days). In patients who received treprostinil, a significant increase in Gram-negative infections was observed (50% vs. 4.5%; P<0.0001). In patients who received epoprostenol, there were significantly more Gram-positive infections (93.2% vs. 33.3%, P<0.0001). There was a trend toward more concomitant immunosuppressive conditions in patients who developed CLABSI (46.7% vs. 31.9%, P=0.09). No patients experienced an infection relapse; 12 patients accounted for 17 reinfections. In patients who developed CLABSI, infection-related LOS was 6 days (4-10 days) and 28-day mortality was 22.2% with a trend towards higher mortality in patients who developed bacteremia on epoprostenol (29.1% vs. 7.7%,P=0.23).

CONCLUSIONSOverall, the incidence of CLABSI was similar to previously published studies. Patients were likely to develop infection within 3 months of line placement and increased risk of CLABSI was seen in those with underlying immunosuppressive conditions.. Therefore, increased infection surveillance may be warranted. Future directions include controlling for severity of illness and outpatient management.