title: Bloodstream infections in patients given treatment with intravenous prostanoids.
abstract: OBJECTIVE
  In September 2006, the Centers for Disease Control and Prevention was notified of cases of gram-negative bloodstream infection (BSI) occurring among outpatients who received an intravenous formulation of the prostanoid treprostinil. An investigation was conducted to determine rates of prostanoid-associated BSI in this patient population and possible risk factors for infection.
  
  
  METHODS
  We performed a retrospective cohort study of patients who had received intravenous formulations of at least 1 of the 2 approved prostanoids (epoprostenol and treprostinil) from January 1, 2004, through late 2006. Chart reviews were conducted at 2 large centers for pulmonary arterial hypertension, and a survey of infection control practices was conducted at 1 center.
  
  
  RESULTS
  A total of 224 patients were given intravenous prostanoid treatment, corresponding to 146,093 treatment-days during the study period. Overall, there were 0.55 cases of BSI and 0.18 cases of BSI due to gram-negative organisms per 1,000 treatment-days. BSI rates were higher for patients who received intravenous treprostinil than for patients who received intravenous epoprostenol (1.13 vs. 0.42 BSIs per 1,000 treatment-days; P < .001), as were rates of BSI due to gram-negative organisms (0.81 vs. 0.04 BSIs per 1,000 treatment-days; P < .001). Adjusted hazard ratios for all BSIs and for BSIs due to gram-negative organisms were higher among patients given treatment with intravenous treprostinil. The survey identified no significant differences in medication-related infection control practices.
  
  
  CONCLUSIONS
  At 2 centers, BSI due to gram-negative pathogens was more common than previously reported and was more frequent among patients given treatment with intravenous treprostinil than among patients given treatment with intravenous epoprostenol. Whether similar results would be found at other centers for pulmonary arterial hypertension warrants further investigation. This investigation underscores the importance of surveillance and evaluation of healthcare-related adverse events in patients given treatment primarily as outpatients.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. AKallen@cdc.gov
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.forename: Edith
authors.initials: E
authors.lastname: Lederman
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balaji
authors.forename: Ingrid
authors.initials: I
authors.lastname: Trevino
authors.forename: Emily E
authors.initials: EE
authors.lastname: Petersen
authors.forename: Rivka
authors.initials: R
authors.lastname: Shoulson
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Horn
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.forename: Robyn J
authors.initials: RJ
authors.lastname: Barst
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000635:transmission*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000635:transmission*; D018718:Home Infusion Therapy / Q000009:adverse effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D016016:Proportional Hazards Models; D011453:Prostaglandins / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D011453:Prostaglandins; D011464:Epoprostenol; C427248:treprostinil