Polyzou Eleni, Ntalaki Evangelia, Efthymiou Dimitrios, Papageorgiou Despoina, Gavatha Maria, Rigopoulos Emmanouil Angelos, Skintzi Katerina, Tsoupra Stamatia, Manios Konstantinos, Baikoussis Nikolaos G, Akinosoglou Karolina
Department of Medicine, University of Patras, 26504 Patras, Greece.
Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece.
J Clin Med. 2025 Jun 16;14(12):4262. doi: 10.3390/jcm14124262.
Infective endocarditis (IE) during pregnancy, while uncommon, is associated with substantial maternal and fetal morbidity and mortality due to the complex physiological adaptations of pregnancy. Hemodynamic alterations, including increased cardiac output and changes in vascular resistance, combined with immunological modulation, predispose pregnant individuals to increased risk of infection and associated complications. Predominant pathogens implicated in pregnancy-associated IE are , , and , with infections frequently leading to poorer clinical outcomes. Diagnosis remains challenging due to commonly atypical presentation and relies on microbiological identification via blood cultures in conjunction with imaging modalities such as transthoracic echocardiography. IE in pregnancy is associated with increased maternal mortality rates (5-17%) and adverse fetal outcomes, including preterm birth, intrauterine growth restriction (IUGR), and fetal loss. Management necessitates careful selection of antimicrobial therapy to ensure efficacy while minimizing fetal toxicity, especially in settings of increased antimicrobial resistance. Anticoagulation and surgical interventions must be judiciously considered, with surgical timing individualized based on the severity of heart failure and coordinated multidisciplinary care. In conclusion, IE during pregnancy constitutes a significant clinical challenge, underscoring the need for enhanced diagnostic strategies, optimized therapeutic protocols, and the development of pregnancy-specific management guidelines to improve maternal and fetal outcomes.
妊娠期感染性心内膜炎（IE）虽不常见，但由于孕期复杂的生理适应性变化，会导致严重的母婴发病率和死亡率。血流动力学改变，包括心输出量增加和血管阻力变化，再加上免疫调节，使孕妇更容易发生感染及相关并发症。与妊娠相关的IE的主要病原体是 、 和 ， 感染常常导致较差的临床结局。由于临床表现通常不典型，诊断仍然具有挑战性，且依赖于通过血培养进行微生物鉴定，并结合经胸超声心动图等影像学检查手段。妊娠期IE与孕产妇死亡率增加（5%-17%）以及不良胎儿结局相关，包括早产、胎儿生长受限（IUGR）和胎儿死亡。治疗需要谨慎选择抗菌治疗，以确保疗效同时将胎儿毒性降至最低，尤其是在抗菌药物耐药性增加的情况下。必须审慎考虑抗凝和手术干预措施，根据心力衰竭的严重程度个体化确定手术时机，并进行多学科协作的协调护理。总之，妊娠期IE构成了重大的临床挑战，凸显了加强诊断策略、优化治疗方案以及制定针对妊娠的管理指南以改善母婴结局的必要性。
