Shapero Kayle, El-Dalati Sami, Berlacher Kathryn, Megli Christina
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Infectious Disease, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Open Forum Infect Dis. 2023 Sep 20;10(9):ofad470. doi: 10.1093/ofid/ofad470. eCollection 2023 Sep.
The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%), with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of mortality and morbidity, and existing data on outcomes in pregnancy are limited. Our study compares the outcomes of pregnant patients with IE with those of nonpregnant patients.
Patients diagnosed with IE during pregnancy and 30 days postpartum between 2014 and 2021 were identified by International Classification of Diseases, Clinical Modification, Ninth and Tenth Edition codes. Pregnant cases were matched to nonpregnant reproductive-age endocarditis patients in a 1:4 ratio. Data were collected and validated through chart review.
One hundred eighty patients with IE were identified; 34 were pregnant or within 30 days postpartum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. The etiology of IE in pregnant patients was predominantly (methicillin-resistant/sensitive ), whereas nonpregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29%; = .84) and 2-year mortality (20.6% vs 17.8%; > .99) in pregnant patients. There were nonsignificantly higher rates of pulmonary emboli (17.6% vs 7.5%; = .098) and arrhythmia (17.6% vs 9.6%; = .222) among pregnant patients. There were high rates of intravenous drug use relapse in both groups (>40%).
We observed similar rates of mortality in the pregnant IE patients. We observed a microbial predilection for in pregnancy, suggesting that the pregnancy physiology may select for this microbiologic etiology. This study, which represents the largest single-center retrospective review of IE in pregnancy, suggests that surgical intervention may be performed safely in the postpartum period.
妊娠期间感染性心内膜炎（IE）的发病率很低（0.006%），在阿片类药物流行期间患病率有所上升。妊娠合并IE与高死亡率和发病率相关，且现有的关于妊娠结局的数据有限。我们的研究比较了妊娠合并IE患者与非妊娠患者的结局。
通过国际疾病分类临床修订版第九版和第十版编码，确定2014年至2021年期间在妊娠期间及产后30天内被诊断为IE的患者。将妊娠病例与非妊娠育龄期心内膜炎患者按1:4的比例进行匹配。通过病历审查收集并验证数据。
共识别出180例IE患者；34例在诊断时处于妊娠状态或产后30天内。妊娠患者中丙型肝炎和阿片类药物维持治疗的发生率较高。妊娠患者IE的病因主要是（耐甲氧西林/敏感），而非妊娠女性的微生物学差异更大。我们观察到妊娠患者瓣膜置换率（32.4%对29%； = 0.84）和2年死亡率（20.6%对17.8%； > 0.99）相当。妊娠患者肺栓塞（17.6%对7.5%； = 0.098）和心律失常（17.6%对9.6%； = 0.222）的发生率略高，但无统计学意义。两组静脉药物使用复发率均较高（>40%）。
我们观察到妊娠合并IE患者的死亡率相似。我们观察到妊娠期间微生物对有偏好，这表明妊娠生理可能选择了这种微生物病因。这项研究是对妊娠合并IE最大规模的单中心回顾性研究，表明手术干预可在产后安全进行。
