Bloodstream infections related with prostaglandin analogue intravenous administration in severe pulmonary hypertension

TYPE: Abstract Publication TOPIC: Cardiovascular Disease PURPOSE: Compare blood stream infections (BSI) between two intravenous prostacyclin analogues (iPCAs) - iloprost and epoprostenol METHODS: Retrospective analysis of all clinical files of patients under iPCAs from two reference centers in Portugal. RESULTS: 36 periods of continuous iPCAs administration were accounted - 13 iloprost, 23 epoprostenol. Groups were demographically homogeneous. Mean age 43.97, mostly caucasian (94.4%) females (80.6%). In total, patients had 18013 days of therapy by Hickman catheter (median 306, IQA 580), 7685 days (median 355, IQA 591) in iloprost group and 10328 days (median 288, IAQ 659) in epoprostenol group (p=0.383, Fisher’s-exact-test). 27 BSI and 29 agents were identified. BSI was statistically significantly higher in the iloprost group (27.8% vs 2.8%, p<0.001, Fisher’s-exact-test) as well as the prevalence of multiple BSI during each cycle of iPCAs (16.7% vs 0%, p<0.001, Fisher’s-exact-test). The BSI-mortality related was also higher in iloprost group (8.3% vs 0%, p=0.04, Fisher’s-exact-test). There was an overall BSI rate of 1.5/1000 days of treatment, 3.38/1000 in iloprost group and 0.09/1000 in epoprostenol group and patients under iloprost are 99.92% more likely to have a BSI at any time than patients under epoprostenol (HR=0.08, 95%CI 0.010-0.637). CONCLUSIONS: Patients under iloprost had more BSI and related mortality than epoprostenol patients. Epoprostenol patients had remarkably lower rates of BSI than described in literature. CLINICAL IMPLICATIONS: There are no previous studies directly comparing BSI rates between intravenous epoprostenol and iloprost administration. It is important to alert physicians about these results to guarantee their patients safety and best medical care. DISCLOSURE: No significant relationships. KEYWORD: pulmonary hypertension, bloodstream infection, prostaglandin analogue