title: High incidence of bloodstream infection due to gram-negative bacilli in patients with pulmonary hypertension receiving intravenous treprostinil.
abstract: BACKGROUND
  An excessive risk for bacteremia has recently been reported in patients with pulmonary arterial hypertension (PAH) treated with intravenous treprostinil. We aimed to assess this association in a cohort of patients from a Spanish referral center.
  
  
  METHODS
  We performed a retrospective cohort study that included 55 patients diagnosed with PAH who received a continuous intravenous infusion of a prostanoid (epoprostenol or treprostinil) for ≥1month at our center between January 1991 and December 2011. The risk factors associated with the incidence of bacteremia were analyzed with the log-rank test.
  
  
  RESULTS
  After a total follow-up of 64,453 treatment days, we found 12 episodes of bacteremia: Staphylococcus aureus (5 episodes), non-fermenting gram-negative bacilli (4 episodes), other gram-positive cocci (2 episodes), and Enterobacter cloacae (one episode). The incidence of bacteremia was 0.118 episodes per 1,000 treatment days in patients receiving epoprostenol versus 0.938 episodes per 1,000 treatment-days in patients receiving treprostinil (P=.0037). All episodes of bacteremia due to Gram-negative bacilli were diagnosed in patients on treprostinil. In the univariate analysis the treatment with intravenous treprostinil was associated with the incidence of bacteremia (hazard ratio: 4.09; 95% confidence interval: 1.24-14.53), although the low number of events prevented us from performing a multivariate analysis.
  
  
  CONCLUSIONS
  Therapy with intravenous treprostinil is associated with a higher risk for bacteremia, especially due to non-fermenting Gram-negative bacilli. This association should be taken in consideration when choosing empirical antibiotic therapy for patients with PAH and sepsis.
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: María José
authors.initials: MJ
authors.lastname: Ruiz-Cano
authors.forename: Elvira
authors.initials: E
authors.lastname: Barrios
authors.forename: María
authors.initials: M
authors.lastname: Vicente-Hernández
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016470:Bacteremia / Q000139:chemically induced* / Q000453:epidemiology*; D015331:Cohort Studies; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006090:Gram-Negative Bacteria; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil