title: Bloodstream infections in patients with pulmonary arterial hypertension treated with intravenous prostanoids: insights from the REVEAL REGISTRY®.
abstract: OBJECTIVE
  To evaluate the rate of and potential risk factors for bloodstream infections (BSIs) using data from the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension [PAH] Disease Management) REGISTRY(®), which provides current information about patients with PAH.
  
  
  METHODS
  Patients were enrolled from March 30, 2006, through December 8, 2009, and data on reported BSIs were collected through the third quarter of 2010. Bloodstream infection rates were calculated per 1000 patient-days of risk.
  
  
  RESULTS
  Of 3518 patients enrolled, 1146 patients received intravenous (IV) prostanoid therapy for more than 1 day (no BSI, n=1023; ≥1 BSI, n=123; total BSI episodes, n=166). Bloodstream infections rates were significantly increased in patients receiving IV treprostinil vs IV epoprostenol (0.36 vs 0.12 per 1000 treatment days; P<.001), primarily due to gram-negative organisms (0.20 vs 0.03 per 1000 treatment days; P<.001). Multivariate analysis adjusting for age, causes of PAH, and year of BSI found that treatment with IV treprostinil was associated with a 3.08-fold increase (95% confidence interval, 2.05-4.62; P<.001) in BSIs of any type and a 6.86-fold increase (95% confidence interval, 3.60-13.07; P<.001) in gram-negative BSIs compared with treatment with IV epoprostenol.
  
  
  CONCLUSIONS
  Compared with IV epoprostenol therapy, treatment with IV treprostinil is associated with a significantly higher rate of gram-negative BSIs; observed differences in BSI rate did not seem to be due to any other analyzed factors.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00370214.
authors.affiliation: Pulmonary and Critical Care Division, Heart and Lung Center, Intermountain Medical Center, Salt Lake City, UT, USA. natalie.kitterman@imail.org
authors.forename: Natalie
authors.initials: N
authors.lastname: Kitterman
authors.forename: Abby
authors.initials: A
authors.lastname: Poms
authors.forename: Dave P
authors.initials: DP
authors.lastname: Miller
authors.forename: Sandra
authors.initials: S
authors.lastname: Lombardi
authors.forename: Harrison W
authors.initials: HW
authors.lastname: Farber
authors.forename: Robyn J
authors.initials: RJ
authors.lastname: Barst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016009:Chi-Square Distribution; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D011464:Epoprostenol / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011453:Prostaglandins / Q000008:administration & dosage* / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D011453:Prostaglandins; D011464:Epoprostenol; C427248:treprostinil