title: Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension.
abstract: Catheter-related blood stream infection (CR-BSI) in patients with pulmonary hypertension (PH) receiving intravenous iloprost via an indwelling central line has previously not been fully described. Recent studies have suggested a link between the pH of prostanoid infusions and the rate and nature of CR-BSI. We have investigated CR-BSI in patients receiving intravenous iloprost at our unit. Databases and hospital records were interrogated for all patients receiving intravenous iloprost between September 2007 and June 2012. Fifty-nine patients received intravenous iloprost via an indwelling central catheter with a total of 23,072 treatment days. There were 15 episodes of CR-BSI, identified using a systematic screening protocol, involving 11 patients giving an overall CR-BSI rate of 0.65/1,000 treatment days. CR-BSI rate for Gram-positive organisms was 0.26/1,000 treatment-days and for Gram-negative organisms was 0.39/1,000 treatment-days. The pH of iloprost in typical dosing regimens was comparable to the pH used in standard-diluent treprostinil and dissimilar to alkaline epoprostenol infusions. The proportion of Gram-negative CR-BSI was similar to that reported for standard-diluent treprostinil. CRP was normal on admission in 33 % of cases of confirmed CR-BSI and remained normal in 13 % of cases. CR-BSI rates with intravenous iloprost are comparable to those observed for other prostanoids. The high proportion of Gram-negative organisms observed and the neutral pH of iloprost infusions support the previously hypothesised link between pH and antimicrobial activity. Although usually elevated during a CR-BSI, CRP may be normal in early infection and a normal result cannot completely exclude infection.
authors: Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
authors: D
authors: D
authors: Sammut
authors: C A
authors: CA
authors: Elliot
authors: D G
authors: DG
authors: Kiely
authors: I J
authors: IJ
authors: Armstrong
authors: L
authors: L
authors: Martin
authors: J
authors: J
authors: Wilkinson
authors: P
authors: P
authors: Sephton
authors: J
authors: J
authors: Jones
authors: N
authors: N
authors: Hamilton
authors: J
authors: J
authors: Hurdman
authors: E
authors: E
authors: McLellan
authors: I
authors: I
authors: Sabroe
authors: R
authors: R
authors: Condliffe
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000139:chemically induced*; D055499:Catheter-Related Infections / Q000139:chemically induced*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D016285:Iloprost / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D016285:Iloprost
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