Department of Pediatrics, Division of Critical Care, Mattel Children's Hospital UCLA, Los Angeles, CA 90095, USA.
Infection. 2013 Jun;41(3):719-22. doi: 10.1007/s15010-012-0399-2. Epub 2013 Jan 18.
Treprostinil is a prostacyclin analogue approved for the treatment of pulmonary arterial hypertension (PAH). It is commonly administered through a central venous catheter (CVC). Treprostinil is associated with the incidence of Gram-negative bacterial bloodstream infections (BSI), a susceptibility that has been associated with a diluent used for treprostinil. We report the case of a 14-year-old boy with idiopathic PAH on continuous intravenous treprostinil therapy who presented with fever and fatigue. A blood culture drawn from his CVC was positive for the rare Gram-negative organism Chryseomonas luteola. The patient made a complete recovery with antibacterial treatment. This is the only documented case of a C. luteola BSI in a PAH patient receiving continuous intravenous treprostinil. We recommend maintaining a high index of suspicion for both common and rare Gram-negative pathogens and the early administration of appropriate antibiotic therapy in this population. The use of an alternate diluent solution, such as Sterile Diluent for Flolan, further decreases the infection risk.
曲前列尼尔是一种前列环素类似物，已被批准用于治疗肺动脉高压（PAH）。它通常通过中心静脉导管（CVC）给药。曲前列尼尔与革兰氏阴性菌血流感染（BSI）的发生率有关，这种易感性与用于曲前列尼尔的稀释剂有关。我们报告了一例 14 岁患有特发性 PAH 的男孩，他正在接受连续静脉注射曲前列尼尔治疗，出现发热和疲劳。从他的 CVC 中抽取的血培养物对罕见的革兰氏阴性生物体黄单胞菌呈阳性。患者经抗菌治疗完全康复。这是在接受连续静脉注射曲前列尼尔治疗的 PAH 患者中唯一记录到的黄单胞菌 BSI 病例。我们建议在该人群中保持对常见和罕见革兰氏阴性病原体的高度警惕，并尽早给予适当的抗生素治疗。使用替代稀释剂溶液，如 Flolan 的无菌稀释剂，进一步降低感染风险。
