Dahshan Deena, Suliman Mohamed, Rahman Ebad U, Curtis Zachary, Thompson Ellen
Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2021 Aug 16;13(8):e17218. doi: 10.7759/cureus.17218. eCollection 2021 Aug.
Introduction Due to high levels of intravenous drug use (IVDU) in West Virginia (WV), there are increasing numbers of hospitalizations for infective endocarditis (IE). More specifically, pregnant patients with IE are a uniquely challenging population, with complex management and a clinical course that further affects the health of the fetus, with high morbidity and mortality. Timely recognition and awareness of the most common bacterial causes will provide hospitals and clinicians with valuable information to manage future patients. Methods This retrospective study analyzed the clinical course of pregnant patients admitted with IE and IVDU history presenting at Cabell Huntington Hospital from 2013 to 2018. Inclusion criteria were women between 16 and 45 years of age confirmed to be pregnant by urine pregnancy test and ultrasonography with at least eight weeks gestation, with a first-time diagnosis of endocarditis and an identified history of IVDU. We excluded charts with pre-existing risk factors including a history of valvular disease, rheumatic heart disease, surgical valve repair or mechanical valve replacement, or a diagnosis of coagulopathies. The resulting charts were evaluated for isolated organisms, reported clinical course, and complications of the pregnancy. Results A total of 10 patients were identified, with methicillin-susceptible and methicillin-resistant , , and species. Complications included loss of fetus (30%), septic embolization (40%), hemorrhagic stroke (10%), and transfer to outside facilities for cardiothoracic surgical intervention (40%). Discussion IE in pregnancy, while rare, has serious complications. In the context of the IVDU epidemic, it has an increasing impact on WV hospitals. A better understanding of the clinical course may allow for early diagnosis and guide the development of rational empiric therapies. More effective management of IE in pregnant patients can reduce complications and potentially improve maternal and fetal morbidity or mortality.
引言 由于西弗吉尼亚州（WV）静脉注射吸毒（IVDU）的比例较高，感染性心内膜炎（IE）导致的住院人数不断增加。更具体地说，患有IE的孕妇是一个极具挑战性的群体，其管理复杂，临床病程会进一步影响胎儿健康，发病率和死亡率都很高。及时识别和了解最常见的细菌病因将为医院和临床医生管理未来患者提供有价值的信息。方法 这项回顾性研究分析了2013年至2018年在卡贝尔·亨廷顿医院就诊的有IE病史和IVDU史的孕妇的临床病程。纳入标准为年龄在16至45岁之间、经尿妊娠试验和超声检查确诊怀孕且妊娠至少8周、首次诊断为心内膜炎并有IVDU史的女性。我们排除了具有先前危险因素的病历，包括瓣膜病、风湿性心脏病、外科瓣膜修复或机械瓣膜置换史，或凝血障碍诊断。对所得病历进行评估，以确定分离出的病原体、报告的临床病程和妊娠并发症。结果 共确定了10例患者，分离出对甲氧西林敏感和耐药的 、 、 和 菌种。并发症包括胎儿丢失（30%）、脓毒性栓塞（40%）、出血性中风（10%）以及转至外部机构进行心胸外科手术干预（40%）。讨论 妊娠期IE虽然罕见，但有严重并发症。在IVDU流行的背景下，它对WV医院的影响越来越大。更好地了解临床病程可能有助于早期诊断并指导合理经验性治疗的制定。对孕妇IE进行更有效的管理可以减少并发症，并有可能改善母婴发病率或死亡率。
