Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

Kayle Shapero; Sami El-Dalati; Kathryn Berlacher; Christina Megli

doi:10.1093/ofid/ofad470

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

Open Forum Infect Dis. 2023 Sep 20;10(9):ofad470. doi: 10.1093/ofid/ofad470. eCollection 2023 Sep.

Authors

Kayle Shapero¹, Sami El-Dalati², Kathryn Berlacher¹, Christina Megli³

Affiliations

¹ Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
² Department of Infectious Disease, University of Kentucky Medical Center, Lexington, Kentucky, USA.
³ Department of Obstetrics, Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine, Magee Women's Research Institute, Pittsburgh, Pennsylvania, USA.

Abstract

Background: 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.

Methods: 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.

Results: 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 S. aureus (methicillin-resistant/sensitive S. aureus), whereas nonpregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29%; P = .84) and 2-year mortality (20.6% vs 17.8%; P > .99) in pregnant patients. There were nonsignificantly higher rates of pulmonary emboli (17.6% vs 7.5%; P = .098) and arrhythmia (17.6% vs 9.6%; P = .222) among pregnant patients. There were high rates of intravenous drug use relapse in both groups (>40%).

Conclusions: We observed similar rates of mortality in the pregnant IE patients. We observed a microbial predilection for S. aureus 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.

Keywords: infective endocarditis; maternal mortality and morbidity; opioid use disorder; pregnancy.