We would like to thank Dr Gómez Sánchez1 for his close reading and comments of our article on catheter-associated bloodstream infection in patients with pulmonary hypertension receiving intravenous treprostinil.2 In this letter, we would like to mention the article by Kitterman et al.,3 which was published after our manuscript was accepted for publication by Archivos de Bronconeumología. Some conclusions have been drawn from the analysis of this registry3 that coincide with those of our study and with the results of previous studies carried out in the United States, which we cite in our article. In all of these papers, a significantly greater risk of bacteraemia is observed in patients receiving intravenous infusions of treprostinil, particularly bacteraemia due to gram-negative bacilli, than in patients treated with epoprostenol.

In our series, the distribution over time of the 5 episodes of bloodstream infection detected during the study period (1991–2011) in patients receiving intravenous treprostinil was as follows: 2 episodes in 2008 and 3 episodes in 2010. To this we can add that outside the follow-up period, between January and September 2012, four patients in our hospital received intravenous treprostinil of which one developed Pseudomonas aeruginosa subcutaneous tunnel infection, associated with the vascular catheter for drug delivery, and another developed vascular catheter-related bacteraemia, also caused by Pseudomonas aeruginosa. The small number of patients receiving treprostinil (10 in total), the limited number of episodes of bacteraemia and the short follow-up period make us cautious about drawing conclusions regarding a trend over time in the incidence of this complication.

The experience that we reported, together with other studies performed in North America, can be regarded as yet another element to be taken into consideration when making decisions on the use of prostanoids in the treatment of patients with pulmonary arterial hypertension.

We fully agree with Dr Gómez Sánchez in emphasising the use of strict aseptic methods in the insertion and handling of venous access catheters for the infusion of prostanoids. The complications associated with the intravenous infusion of prostanoids have led to the development of alternative forms of delivery, including a subcutaneous continuous infusion pump. Of the 85 patients followed in our hospital in whom this alternative method of infusion was used, no significant episodes of local or systemic infection have been recorded to date, so we currently consider this to be the method of choice for the administration of treprostinil.