{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:33:29Z","timestamp":1766579609935,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>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% (n = 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\u201399.092). A higher mortality rate from BSI was also identified in the iloprost group (p = 0.04). Twenty-seven patients developed BSI, with 92% of them requiring hospitalization. A total of 29 agents were found, 10 Gram-positive (mainly Staphylococcus aureus; n = 5) and 19 Gram-negative (mainly Pseudomonas aeruginosa; n = 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\u2019 safety and best medical care.<\/jats:p>","DOI":"10.3390\/ijms24076434","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T02:23:46Z","timestamp":1680143026000},"page":"6434","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Incidence of Bloodstream Infection in Patients with Pulmonary Hypertension under Intravenous Epoprostenol or Iloprost\u2014A Multicentre, Retrospective Study"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7281-0406","authenticated-orcid":false,"given":"Raquel Paulinetti","family":"Camara","sequence":"first","affiliation":[{"name":"Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal"},{"name":"Pulmonology Department, Hospital Nossa Senhora do Ros\u00e1rio, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3762-7136","authenticated-orcid":false,"given":"Francisco das Neves","family":"Coelho","sequence":"additional","affiliation":[{"name":"Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal"},{"name":"Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, 1349-019 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5934-5201","authenticated-orcid":false,"given":"Nat\u00e1lia","family":"Cruz-Martins","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"},{"name":"Institute for Research and Innovation in Health (i3S), University of Porto, 4099-002 Porto, Portugal"},{"name":"Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 4585-116 Gandra, Portugal"},{"name":"TOXRUN\u2014Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal"}]},{"given":"Patr\u00edcia","family":"Marques-Alves","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Disease Unit, Cardiology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, 3004-561 Coimbra, Portugal"}]},{"given":"Gra\u00e7a","family":"Castro","sequence":"additional","affiliation":[{"name":"Pulmonary Vascular Disease Unit, Cardiology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, 3004-561 Coimbra, Portugal"}]},{"given":"Rui","family":"Baptista","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"},{"name":"ICBR\u2014Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2555-4176","authenticated-orcid":false,"given":"Filipa","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"ref_1","first-page":"903","article-title":"Guidelines on diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology and of the European Respiratory Society","volume":"46","author":"Hoeper","year":"2015","journal-title":"Eur. 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