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Bloodstream Infections in Patients Given Treatment With Intravenous Prostanoids

Published online by Cambridge University Press:  02 January 2015

Alexander J. Kallen*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Edith Lederman
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Alexandra Balaji
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Ingrid Trevino
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Emily E. Petersen
Affiliation:
CDC Experience Fellowship, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Rivka Shoulson
Affiliation:
Epidemiology Elective Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Lisa Saiman
Affiliation:
Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York Departments of Epidemiology, New York-Presbyterian Hospital, New York, New York
Evelyn M. Horn
Affiliation:
Medicine, New York-Presbyterian Hospital, New York, New York
Mardi Gomberg-Maitland
Affiliation:
Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
Robyn J. Barst
Affiliation:
Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road NE, MS A-35, Atlanta, GA 30333 (AKallen@cdc.gov)

Abstract

Objective.

In September 2006, the Centers for Disease Control and Prevention was notified of cases of gram-negative bloodstream infection (BSI) occurring among outpatients who received an intravenous formulation of the prostanoid treprostinil. An investigation was conducted to determine rates of prostanoid-associated BSI in this patient population and possible risk factors for infection.

Methods.

We performed a retrospective cohort study of patients who had received intravenous formulations of at least 1 of the 2 approved prostanoids (epoprostenol and treprostinil) from January 1, 2004, through late 2006. Chart reviews were conducted at 2 large centers for pulmonary arterial hypertension, and a survey of infection control practices was conducted at 1 center.

Results.

A total of 224 patients were given intravenous prostanoid treatment, corresponding to 146,093 treatment-days during the study period. Overall, there were 0.55 cases of BSI and 0.18 cases of BSI due to gram-negative organisms per 1,000 treatment-days. BSI rates were higher for patients who received intravenous treprostinil than for patients who received intravenous epoprostenol (1.13 vs. 0.42 BSIs per 1,000 treatment-days; P < .001), as were rates of BSI due to gram-negative organisms (0.81 vs. 0.04 BSIs per 1,000 treatment-days; P < .001). Adjusted hazard ratios for all BSIs and for BSIs due to gram-negative organisms were higher among patients given treatment with intravenous treprostinil. The survey identified no significant differences in medication-related infection control practices.

Conclusion.

At 2 centers, BSI due to gram-negative pathogens was more common than previously reported and was more frequent among patients given treatment with intravenous treprostinil than among patients given treatment with intravenous epoprostenol. Whether similar results would be found at other centers for pulmonary arterial hypertension warrants further investigation. This investigation underscores the importance of surveillance and evaluation of healthcare-related adverse events in patients given treatment primarily as outpatients.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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