Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal.
Pulmonology Department, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal.
Int J Mol Sci. 2023 Mar 29;24(7):6434. doi: 10.3390/ijms24076434.
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% ( = 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 ( = 0.04). Twenty-seven patients developed BSI, with 92% of them requiring hospitalization. A total of 29 agents were found, 10 Gram-positive (mainly ; = 5) and 19 Gram-negative (mainly ; = 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.
静脉内合成前列环素类似物（iPCAs），如依前列醇、曲前列尼尔和伊洛前列素，已被广泛用于治疗肺动脉高压（PAH）。尽管有良好的疗效，但 iPCAs 的持续输注与一些不良反应有关。血流感染（BSI）是最严重的并发症之一，尽管认识不足，尤其是在伊洛前列素给药时，很少有研究涉及到这一点。本研究旨在比较静脉内伊洛前列素和依前列醇给药的 BSI 发生率。从 2004 年至 2019 年，从两个肺动脉高压治疗中心回顾性选择接受静脉内伊洛前列素或依前列醇通过 Hickman 导管治疗的肺动脉高压（PH）功能 III 或 IV 级患者。共有 36 名患者（伊洛前列素 13 例，依前列醇 23 例），75%（=27）符合 PAH 标准，主要属于特发性组。总体 BSI 发生率为 1.5/1000 天治疗（伊洛前列素和依前列醇分别为 3.38 和 0.09/1000 天）。接受伊洛前列素治疗的患者发生 BSI 的风险高于接受依前列醇治疗的患者（HR：12.5；95%CI：1.569-99.092）。伊洛前列素组 BSI 相关死亡率也较高（=0.04）。27 名患者发生 BSI，其中 92%需要住院治疗。共发现 29 种药物，10 种革兰阳性菌（主要为；=5）和 19 种革兰阴性菌（主要为；=6）。与依前列醇相比，伊洛前列素治疗与 BSI 发生率显著升高、预后较差和更多 BSI 相关死亡相关。伊洛前列素组革兰阴性、共生、低毒力细菌引起的 BSI 也更高。总之，医生在开具 iPCA 处方时应注意保证患者的安全和最佳医疗护理。
