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Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension

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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.

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Financial support

None reported.

Potential conflicts of interest

CAE reports having received funding for attending conferences, lecturing and advisory boards from Actelion, Bayer, GSK and Pfizer.

DGK reports receiving funding for attending conferences, lecturing and advisory boards from Actelion, Bayer, GSK, Pfizer and Lily.

IJA reports receiving funding for attending conferences from Actelion, Bayer, GSK and Pfizer, honoraria for lecturing from Actelion, GSK, Pfizer and Bayer and being on the advisory boards of Actelion, Pfizer and GSK.

JJ, LM, JW and PS report receiving funding for attending conferences from Actelion and GSK.

NH reports receiving funding for attending conferences from Actelion, Bayer, GSK and Pfizer and honoraria for lecturing from Actelion and GSK.

JH reports receiving funding for attending conferences from Actelion, GSK and Pfizer.

IS reports receiving funding for attending conferences from Actelion.

RC reports having received funding for attending conferences and lecturing from Actelion, Bayer, GSK and Pfizer as well as funding for advisory boards from Lily.

DS and EM report no conflicts of interest.

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Authors and Affiliations

  1. Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK

    D. Sammut, C. A. Elliot, D. G. Kiely, I. J. Armstrong, L. Martin, J. Wilkinson, P. Sephton, J. Jones, N. Hamilton, J. Hurdman, I. Sabroe & R. Condliffe

  2. Academic Unit of Respiratory Medicine, Department of Infection and Immunity, School of Medicine, University of Sheffield, Sheffield, UK

    D. Sammut & I. Sabroe

  3. Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    E. McLellan

Authors
  1. D. Sammut
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  2. C. A. Elliot
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  3. D. G. Kiely
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  4. I. J. Armstrong
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  5. L. Martin
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  6. J. Wilkinson
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  7. P. Sephton
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  8. J. Jones
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  9. N. Hamilton
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  10. J. Hurdman
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  11. E. McLellan
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  12. I. Sabroe
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  13. R. Condliffe
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Corresponding author

Correspondence to R. Condliffe.

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Sammut, D., Elliot, C.A., Kiely, D.G. et al. Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension. Eur J Clin Microbiol Infect Dis 32, 883–889 (2013). https://doi.org/10.1007/s10096-013-1822-z

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  • DOI: https://doi.org/10.1007/s10096-013-1822-z

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