Infective Endocarditis as a Complication of Intravenous Drug Use in Pregnancy: A Retrospective Case Series and Literature Review

Abstract

Objective An increase in opioid use disorder and subsequent intravenous drug use has led to an increase in sequalae that may complicate pregnancy, such as infective endocarditis. Infective endocarditis has the potential for significant maternal and neonatal morbidity and mortality. We sought to examine the management considerations and clinical implications of intravenous drug use-related infective endocarditis in pregnancy from our center's experience. Study Design Retrospective study of management of pregnancies complicated by infective endocarditis as a result of active intravenous drug use at an academic tertiary care hospital from January 2012 through December 2019. Results Twelve women with active intravenous drug use histories were identified as having clinical and echocardiographic features consistent with infective endocarditis. Six women were discharged against medical advice and did not complete the full course of recommended antibiotic regimen. Eight women were started or continued on opioid agonist therapy during their hospitalization. Four neonates required neonatal intensive care unit admission for pharmacologic treatment for neonatal abstinence syndrome. Conclusion Management of intravenous drug use-associated infective endocarditis in pregnancy involves more than treating the acute condition. In pregnant women with opioid use disorder and infective endocarditis, addiction and chronic psychosocial conditions need to be addressed to optimize care.

Infective endocarditis in pregnant women without intravenous drug use: a multicentre retrospective case series

“…Maternal mortality has decreased in comparison to old series, 5,6 probably due to a higher prevalence of IVDU patients who are usually younger and have right-sided IE, both being associated with a better prognosis. However, in our series that does not include IVDU patients, maternal mortality is also lower.…”

“…Previous studies focused on IE in pregnant women with IVDU, [5][6][7] and found that the most common aetiology was staphylococci, with a predominance of right-sided IE, and no need for surgical treatment in most cases. 5,6 In the study reported herein, we found mostly left-sided IE, with streptococcal predominance and a high rate of cardiac surgery, probably related to the fact that IVDU women were excluded.…”

“…4 The main reported risk factors are IVDU and congenital or rheumatic cardiac diseases, but in most recent series women with IVDU are the predominant group. [5][6][7] Although lower than previously reported, maternal and fetal mortality are still around 5%-11% and 0%-16%, respectively. [3][4][5][6]8 Contemporary clinical characteristics and prognosis of pregnant women with IE who do not inject drugs remain unknown.…”

“…[5][6][7] Although lower than previously reported, maternal and fetal mortality are still around 5%-11% and 0%-16%, respectively. [3][4][5][6]8 Contemporary clinical characteristics and prognosis of pregnant women with IE who do not inject drugs remain unknown. The aim of this study was to describe the clinical features and outcomes of a contemporary multinational cohort of IE in pregnant women who do not inject drugs.…”

Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series

“… 11 , 12 Historically patients with injection drug use and/or pregnancy have high rates of patient-directed discharges and failure of antibiotic completion. 18 , 19 Encouragingly, there were no patient-directed discharges after involvement of the multidisciplinary endocarditis team.…”