Infective endocarditis in pregnancy from 2009 to 2019: the consequences of injection drug use

Sinner, Gregory; Annabathula, Rahul; Viquez, Karolina; Alnabelsi, Talal; Leung, Steve W.

doi:10.1080/23744235.2021.1912821

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…In the scenario of intravenous drug use, the role of surgery is even more contentious since the danger of recurrence is high (4). It must be emphasized, however, that when IE involves right-sided valves, as is often the case in intravenous drug use, surgery is most often not necessary, and mortality is lower (47). In pregnant women presenting with acute heart failure secondary to acute valve regurgitation, immediate surgery is indicated.…”

Section: Discussionmentioning

confidence: 99%

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

Oliveira¹,

Fraife²,

Barbosa³

et al. 2022

HVT

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Objective: Pregnancy and postpartum infective endocarditis (PPIE), although uncommon, is a very serious condition. To describe cases of infectious endocarditis (IE) in in a cohort of adults with IE in a Brazilian center and to review data from the recent literature on the subject. Methods: Cases of definite IE by the modified Duke criteria in adults were retrieved in a contemporary cohort of adults with IE from January 2006 to December 2020. Literature review on the topic was carried out and case reports on PPIE from 2014 to 2020 were compiled. Results: Two cases of PPIE were found in 401 adult patients with IE, with a prevalence of 0.5% in the cohort, of 2/139 (1.4%) among women and 2/83 (2.4%) of women of reproductive age (18 -49 years) in this same cohort. The search for published case reports from 2014 to 2020 resulted in 61 episodes of PPIE; in these, 7 pregnant women (11.4%), 10 fetuses (16.4%) and 1 premature newborn (1.6%) died. There was a previous valve predisposition in 12 (19.7%) cases and intravenous drug use in 14(23%). Left-sided valves were the most frequently affected in 41 (67.2%) of the cases. The most common isolated infectious agent was methicillin sensitive Staphylococcus aureus in 18/61 (29.5%) patients, although as a group, oral viridans streptococci accounted for 16/61 (26.2%). Valve surgery was done for 70% of patients. Conclusions: Intravenous drug use remained to be the main risk factor for IE. Mortality remained high for mothers and their children, despite the fact surgery was done more frequently in the recent cases. In the case of fever without an obvious focus in pregnant or post-partum women, the diagnosis of IE must be readily considered, especially in those with prosthesis and/or intravenous drug use.

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Section: Discussionmentioning

confidence: 99%

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

Oliveira¹,

Fraife²,

Barbosa³

et al. 2022

HVT

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 90%

“…[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.…”

Section: Introductionmentioning

confidence: 90%

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

Escolà-Vergé

Rello

Declerck

et al. 2022

Journal of Antimicrobial Chemotherapy

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Objectives To describe the clinical features and outcomes of infective endocarditis (IE) in pregnant women who do not inject drugs. Methods A multinational retrospective study was performed at 14 hospitals. All definite IE episodes between January 2000 and April 2021 were included. The main outcomes were maternal mortality and pregnancy-related complications. Results Twenty-five episodes of IE were included. Median age at IE diagnosis was 33.2 years (IQR 28.3–36.6) and median gestational age was 30 weeks (IQR 16–32). Thirteen (52%) patients had no previously known heart disease. Sixteen (64%) were native IE, 7 (28%) prosthetic and 2 (8%) cardiac implantable electronic device IE. The most common aetiologies were streptococci (n = 10, 40%), staphylococci (n = 5, 20%), HACEK group (n = 3, 12%) and Enterococcus faecalis (n = 3, 12%). Twenty (80%) patients presented at least one IE complication; the most common were heart failure (n = 13, 52%) and symptomatic embolism other than stroke (n = 4, 16%). Twenty-one (84%) patients had surgery indication and surgery was performed when indicated in 19 (90%). There was one maternal death and 16 (64%) patients presented pregnancy-related complications (11 patients ≥1 complication): 3 pregnancy losses, 9 urgent Caesarean sections, 2 emergency Caesarean sections, 1 fetal death, and 11 preterm births. Two patients presented a relapse during a median follow-up of 3.1 years (IQR 0.6–7.4). Conclusions Strict medical surveillance of pregnant women with IE is required and must involve a multidisciplinary team including obstetricians and neonatologists. Furthermore, the potential risk of IE during pregnancy should never be underestimated in women with previously known underlying heart disease.

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“…While the reported incidence is rare (0.006%), there has been an uptrend in endocarditis complicating pregnancies with the current opioid epidemic. 1 – 3 The cardiovascular physiology adaptations to pregnancy confer a substantial risk of hemodynamic collapse with acute valve failure secondary to endocarditis. Maternal mortality reports have ranged from 10% to 33% with recent studies demonstrating improving outcomes, likely due to early recognition and prompt initiation of treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Shapero

Nauriyal

Megli

et al. 2022

Therapeutic Advances in Infection

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Introduction: 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. Methods: 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. Results: 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; Staphylococcus aureus 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. Discussion: 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. Conclusion: Multidisciplinary endocarditis teams are a low-risk intervention that may improve outcomes in pregnant patients with IE.

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Infective endocarditis in pregnancy from 2009 to 2019: the consequences of injection drug use

Cited by 11 publications

References 32 publications

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

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

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

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