Incidence of Bloodstream Infection in Patients with Pulmonary Hypertension under Intravenous Epoprostenol or Iloprost—A Multicentre, Retrospective Study

Abstract

Intravenous synthetic prostacyclin analogs (iPCAs), such as epoprostenol, treprostinil and iloprost have been widely used for the treatment of pulmonary arterial hypertension (PAH). Despite having good outcomes, continuous infusion of iPCAs has been associated with some adverse effects. Bloodstream infection (BSI) is one of the most severe complications, although poorly recognized, especially under iloprost administration, which few studies have addressed. This study aimed to compare the BSI incidence rates between intravenous iloprost and epoprostenol administration. Patients with pulmonary hypertension (PH) functional class III or IV receiving intravenous iloprost or epoprostenol through Hickman catheter, between 2004 and 2019, were retrospectively selected from two PH treatment centers. From a total of 36 patients (13 for iloprost and 23 for epoprostenol), 75% (n = 27) fulfilled the PAH criteria, mainly belonging to the idiopathic group. Overall BSI rate was 1.5/1000 days of treatment (3.38 and 0.09/1000 days for iloprost and epoprostenol, respectively). Patients receiving iloprost were at a higher risk of developing BSI than those receiving epoprostenol (HR: 12.5; 95% CI: 1.569–99.092). A higher mortality rate from BSI was also identified in the iloprost group (p = 0.04). Twenty-seven patients developed BSI, with 92% of them requiring hospitalization. A total of 29 agents were found, 10 Gram-positive (mainly Staphylococcus aureus; n = 5) and 19 Gram-negative (mainly Pseudomonas aeruginosa; n = 6) bacteria. Iloprost administration was linked to a significantly higher incidence of BSI, worse prognosis, and more BSI-related deaths than epoprostenol. BSI due to Gram-negative, commensal, low-virulence bacteria was also higher in the iloprost group. In short, physicians should be aware when prescribing iPCA to guarantee their patients’ safety and best medical care.

Molecular recognition and activation of the prostacyclin receptor by anti-pulmonary arterial hypertension drugs

“…Sodium salt of PGI 2 (epoprostenol) and its analogs such as iloprost and treprostinil (TRE) were approved by the US Food and Drug Administration (FDA) during 1995-2004 for treatment of PAH (7,14). However, clinical application of the approved IP agonists was limited by its high rate of side effects, possibly caused by its low selectivity for IP (15,16). Since then, selective IP agonists have attracted extensive attention and have been developed for the treatment of PAH (17).…”

Diagnostic values of serum BNP, PTX3, and VEGF in acute pulmonary embolism complicated by pulmonary artery hypertension and their correlations with severity of pulmonary artery hypertension

“…The correct and early increase of pulmonary arterial pressure (PAP) is crucial to decide the proper management and follow‐up for PAH 6 . Great advances have been achieved in the treatment of PAH, but the underlying pathophysiological heterogeneity of PAH impairs treatment efficacy, contributing to elevated morbidity and mortality rate 7 . Since PAH is a progressive, life‐threatening, and irreversible disorder, a simple and available tool for the estimation of the individualized risk and progression of PAH is urgently needed.…”