Shapero Kayle S, Nauriyal Varidhi, Megli Christina, Berlacher Kathryn, El-Dalati Sami
Heart and Vascular Institute, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Ther Adv Infect Dis. 2022 Feb 24;9:20499361221080644. doi: 10.1177/20499361221080644. eCollection 2022 Jan-Dec.
The incidence of infective endocarditis (IE) in pregnancy is rare and has been increasing during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal morbidity and mortality. Multidisciplinary endocarditis teams for management of IE have been shown to reduce in-hospital and 1-year mortality. We present a single-center experience managing IE in pregnancy utilizing a multidisciplinary endocarditis team.
Patients diagnosed with IE while pregnant or within 30 days post-partum were identified. All patients discussed at the institution's weekly multidisciplinary endocarditis meeting were included. Demographic and clinical data and outcome-related variables were retrospectively reviewed and recorded.
Between 1 October 2020 and 1 June 2021 6 pregnant or 30-day post-partum patients with IE were identified. All patients had co-morbid injection drug use; was the etiologic pathogen in all patients. All patients had embolic complications and 5 required ICU admission and mechanical ventilatory support. Four patients underwent valve replacement. There were no patient-directed discharges. All patients survived to hospital discharge and 90-days after diagnosis. Four pregnancies resulted in delivery at an average gestational age of 32.4 weeks with 3 requiring NICU admissions and prolonged lengths of stay. All patients were seen by addiction medicine and 5 were started on medication-assisted treatment for opioid use disorder.
In a small retrospective cases series, coordination of care by a multidisciplinary endocarditis team led to a high-rate of surgical intervention with no patient-directed discharges and no in-hospital or 90-day mortality.
Multidisciplinary endocarditis teams are a low-risk intervention that may improve outcomes in pregnant patients with IE.
妊娠期间感染性心内膜炎（IE）的发病率很低，且在阿片类药物流行期间呈上升趋势。妊娠合并IE与母婴高发病率和死亡率相关。多学科心内膜炎团队管理IE已被证明可降低住院率和1年死亡率。我们介绍了利用多学科心内膜炎团队管理妊娠合并IE的单中心经验。
确定在孕期或产后30天内被诊断为IE的患者。纳入在该机构每周多学科心内膜炎会议上讨论的所有患者。回顾性审查并记录人口统计学和临床数据以及与结局相关的变量。
在2020年10月1日至2021年6月1日期间，确定了6例孕期或产后30天内的IE患者。所有患者均有注射吸毒合并症； 是所有患者的病原体。所有患者均有栓塞并发症，5例需要入住重症监护病房并接受机械通气支持。4例患者接受了瓣膜置换术。没有患者直接出院的情况。所有患者均存活至出院及诊断后90天。4例妊娠平均在孕32.4周时分娩，3例需要入住新生儿重症监护病房且住院时间延长。所有患者均接受了成瘾医学治疗，5例开始接受阿片类药物使用障碍的药物辅助治疗。
在一个小型回顾性病例系列中，多学科心内膜炎团队的护理协调导致了高手术干预率，没有患者直接出院的情况，也没有住院或90天死亡率。
多学科心内膜炎团队是一种低风险干预措施，可能改善妊娠合并IE患者的结局。
