Tunnelled central venous catheter infection during treatment with epoprostenol

• Published in: Revue des maladies respiratoires Vol. 35; no. 3; p. 324
• Main Authors: Koszutski, M, Faure, M, Guillaumot, A, Gomez, E, Mercy, M, Chabot, F, Chaouat, A
• Format: Journal Article
• Language: French
• Published: France 01.03.2018
• Subjects: Actinomycetale infections; Bactériémie; Indwelling catheters; Bacteraemia; Épidémiologie; Cathéters à demeure; Pulmonary arterial hypertension; Epidemiology; Hypertension artérielle pulmonaire; Infections à actinomycetales
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2017.03.037

Pulmonary arterial hypertension is a pulmonary vascular disease with a poor prognosis. Continuous intravenous treatment with prostacyclin analogues requires the placement of a tunnelled catheter. The occurrence of catheter-related infections in this context is unusual due to the alkaline pH of the prostacyclin analogue solutions. A 50-year-old patient with inherited pulmonary artery hypertension, treated with bosentan, sildenafil and epoprostenol, experienced generalized malaise associated with a weight loss of 9kg over a 12-month period without evidence of a source of infection or malignancy. There was no evidence of hemodynamic disturbance. The diagnosis was made after 1 year of follow-up, when the patient presented with a 38° fever and a biological inflammatory syndrome. Repeated peripheral blood cultures were positive for Dietzia, an alkalophilic coryneform bacillus. The patient's condition responded favourably to antibiotic therapy. Infection of a tunneled intravenous catheter should be considered in the case of non-specific symptoms or where there is evidence of sepsis, in patients treated with intravenous prostacyclin analogues administered intravenously. In this context, the laboratory should be warned to search for slow-growing organisms.