Chest
Original ResearchPulmonary Vascular DiseaseThe Effect of Diluent pH on Bloodstream Infection Rates in Patients Receiving IV Treprostinil for Pulmonary Arterial Hypertension
Section snippets
Materials and Methods
This study was performed at the University of Chicago Medical Center (UCMC) and was approved by the institutional review board (IRB No. 13351A). All patients enrolled in this study provided informed consent for entry into our Pulmonary Hypertension Connection registry. The details of this registry have been reported previously.16
Results
Overall, the three cohorts in the study consisted of 25 patients treated with IV treprostinil in epoprostenol diluent, 61 patients treated with IV epoprostenol, and 34 patients treated with IV treprostinil in native diluent from the historical cohort. There were a total of 56,563 treatment days among the three cohorts (12,599 days of IV treprostinil in epoprostenol diluent, 29,889 days of IV epoprostenol, and 14,075 days of IV treprostinil in native diluent).
Baseline characteristics in these
Discussion
In this prospective study of patients with PAH receiving IV prostanoid therapy, the administration of IV treprostinil with the pH-basic epoprostenol diluent resulted in a lower incidence of gram-negative BSI. We found no statistically significant difference in BSI and gram-negative BSI in those treated with IV treprostinil in epoprostenol diluent compared with those treated with IV epoprostenol. These findings highlight the significance of the diluent in infection risk and should ultimately
Limitations
One limitation and potential confounding factor that may have affected our findings is the possible differences among the patient cohorts in terms of catheter care. The historical control cohort of IV treprostinil predated the newest catheter care guidelines and was thus unlikely to have used the closed-hub system or waterproofed connections. Also, all patients in the treprostinil in epoprostenol diluent cohort were reminded to adhere to the catheter care guidelines at the time that their
Conclusions
BSI rates, especially gram-negative infections, in patients with PAH treated with IV treprostinil in epoprostenol diluent are lower than those seen in patients treated with IV treprostinil in its native diluent and similar to those seen in patients treated with epoprostenol. Thus, when treating patients with IV treprostinil in the future, we encourage practitioners to use the alkaline epoprostenol diluent in combination with the use of water-tight seals throughout the delivery system in
Acknowledgments
Author contributions: Dr Rich takes responsibility for the integrity of the work.
Dr Rich: contributed to the design of the study, data analyses, and drafting of the manuscript.
Ms Glassner: contributed to data collection and analyses and manuscript revisions.
Dr Wade: contributed to manuscript revisions.
Ms Coslet: contributed to data collection and manuscript revisions.
Dr Arneson: contributed to data analyses and manuscript revisions.
Ms Doran: contributed to manuscript revisions.
Dr
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2021, Respiratory MedicineCitation Excerpt :These studies included hospitalized patients and different clinical indications such as chemotherapy, total parenteral nutrition and antibiotics administration, factors that may lead to higher rates of central venous catheter–associated BSI [21,22]. The lower incidence of BSI observed in our cohort could be explained by several reasons: mostly ambulatory patients [21], less catheter-hub manipulation due to continuous treatment with use of closed-hub system [23], patient training prior to discharge for the manipulation and self-care [24] and the effect of epoprostenol diluent with a more basic pH, could be protective against this complication [16,25,26]. These data are relevant since the use of PICC is not part of the standardized care strategy for the administration of prostanoids and there are few studies comparing complications between both types of catheters.
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2021, Respiratory MedicineCitation Excerpt :Interestingly, such infections (in particular with gram-negative bacteria) occur to a greater extent with treprostinil than with epoprostenol [139,143,148,149]. Dilution of treprostinil in alkaline solutions rather than neutral solutions decreases the frequency of these infections [150,151]. Our own experiences and those of other working groups indicate that intravenous iloprost therapy via an external pump system can also lead to catheter-associated complications and/or infections (1996–2012 [96,97,100,102,144,147]).
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2018, Heart Failure ClinicsCitation Excerpt :Intravenous treprostinil has the advantage of avoiding the site pain associated with the subcutaneous delivery method; however, the trade-off is the risk of central line infection. The epoprostenol diluent has been used with intravenous treprostinil in an effort to minimize this risk.91 The option of an implantable pump for the delivery of intravenous treprostinil is also under investigation.92,93
Tunnelled central venous catheter infection during treatment with epoprostenol
2018, Revue des Maladies RespiratoiresNotable alkaline tolerance of Kocuria marina isolate from blood of a pediatric patient with continuous intravenous epoprostenol therapy
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Funding/Support: This study was supported by an investigator-initiated grant from United Therapeutics.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).