Endocarditis In Pregnancy Research Articles

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience.

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 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%). 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.

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

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.

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

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.

Maternal and Fetal Outcomes Associated With Infective Endocarditis in Pregnancy.

Infective endocarditis (IE) is a rare but serious infection that complicates pregnancy. Little is known about IE management and outcomes in this population. The National Readmissions Database was used to obtain data between October 2015 and October 2018. Billing codes identified admissions for IE in female patients of reproductive age. Demographic characteristics, comorbidities, and outcomes were compared between patients with maternity-associated and nonmaternity-associated IE and obstetric patients who delivered with and without IE. Weighted regressions were used to examine outcomes in adjusted models. We identified 12 602 reproductive-aged female patients with a diagnosis of IE, of which 382 (weighted national estimate, 748) were maternity-associated. Of these cases, 117 (weighted national estimate, 217) occurred during a delivery admission. Compared with patients with nonmaternity-associated IE, maternity-associated infection was associated with younger age (mean, 29.0 vs 36.6 years; P < .001), Medicaid coverage (72.5% vs 47.2%; P < .001), and drug use (76.2% vs 59.8%; P < .001). Mortality was comparable (8.1% vs 10.6%; adjusted rate ratio [aRR], 1.03; 95% confidence interval [CI]: .71-1.48). Compared with patients who delivered without IE, IE complicating delivery was associated with worse maternal and fetal outcomes, including maternal mortality (17.2% vs <0.01%; aRR, 323.32; 95% CI: 127.74-818.37) and preterm birth (55.7% vs 10.1%; aRR, 3.61; 95% CI, 2.58-5.08). Maternity-associated IE does not appear to confer additional risk for adverse outcome over nonmaternity-associated infection. Patients who deliver with IE have worse maternal and fetal outcomes than those whose deliveries are not complicated by IE.

Diagnosis and treatment of infective endocarditis in pregnancy: a case report

BackgroundPregnancy with infective endocarditis (IE) is rare, but the fetal and maternal mortality rates of these pregnancies are very high, making IE a serious threat to the safety of pregnant women and their fetuses. Therefore, for pregnant women with recurrent fever, a detailed medical history and physical examination should be performed, echocardiography and blood culture should be carried out as soon as possible, multidisciplinary consultation should be implemented, and a diagnosis and treatment plan should be formulated right away, as this is key to saving the lives of mothers and infants.Case introductionA 30-year-old pregnant Chinese woman had IE at 26 weeks of gestation. After close monitoring and care until 31 weeks of gestation, she underwent a successful delivery, cardiac surgery, repair of the patent ductus arteriosus (PDA), mitral valvuloplasty (MVP) and removal of the vegetations. The operation was successful, and further follow-up evaluation showed no abnormality.ConclusionFor the diagnosis and treatment of IE in pregnancy, it is of great importance to implement an individualized diagnosis and treatment plan in combination with close monitoring by echocardiography and to select the right time for cardiac surgery and termination of pregnancy.

Infective Endocarditis in Pregnancy During the Opioid Epidemic [16E

INTRODUCTION: To compare the incidence and complications of infective endocarditis among opioid-using pregnant women from 2006–08 and 2016–18. METHODS: We conducted a cross-sectional analysis of hospitalizations using a publicly available, all-payer inpatient database in Kentucky. Duplicate patients were identified and removed. RESULTS: From 2006–08, 187,178 hospitalizations involved pregnancy of which 1,311 were diagnosed with opioid dependence, use, or abuse. Three of these women had ICD codes for endocarditis (0.23%). From 2016–18, 166,756 hospitalizations involved pregnancy, of which 5,222 were diagnosed with opioid dependence, use, or abuse (+398%). Three of these patients had rheumatic disease, leaving 37 patients (0.71%) with endocarditis related to their opioid use alone, P=.047. The 2016–18 population with endocarditis were white (100%); lived primarily in metropolitan counties (61%); and 57.1% were less than 30 years old. 11% of admissions were in the 1st trimester, 16.2% in the 2nd, 43.2% in the 3rd, and 16.2% postpartum, P=.012. 14% had a spontaneous or missed abortion. The median length of stay was 22.5 days. Ten deliveries were complicated by endocarditis, six by cesarean section. Five women underwent valvular surgery in 2016–18: four valve replacements and one total valve excision. Of the hospitalizations with a maternal mortality for 2016–18, three were complicated by endocarditis. CONCLUSION: A four-fold increase in hospitalization complicated by opioid use was observed as well as a significant increase in the rate of infective endocarditis in this population. Endocarditis contributed to maternal mortality, life-threatening morbidities, prolonged hospital stay, and increased cost.

Cardiac implant and the risk of infective endocarditis in pregnancy

Abstract Objectives Infective endoplastitis/endocarditis (IE) due to a cardiac implant is an extremely rare event during pregnancy. Management and prognosis is not well known in this population. Case presentation A 29-year-old woman, gravida 1 para 0, at 19 3/7 weeks gestation with an Amplatzer septal occluder presented to the hospital with fever. A transesophageal echocardiogram demonstrated cardiac vegetations. She subsequently underwent cardiopulmonary bypass surgery with fetal monitoring to remove the device and eventually went on to deliver a full-term infant. Conclusions IE should be on the differential in patients with cardiac device. Multidisciplinary efforts enable prompt initiation of treatment after weighing the risks and benefits to both mother and fetus. Lastly, the fetal status can be utilized to assess for hemodynamic status of the mother.

608: Incidence, risk factors and mortality associated with infective endocarditis in pregnancy

Infective endocarditis (IE) during pregnancy is an extremely rare, yet potentially devastating event. It likely increases both maternal and fetal mortality and morbidity; however, no comprehensive study has been conducted to quantify this risk. Therefore, the purpose of this study was to evaluate the risks, outcomes, and predictors of death among pregnancies complicated with IE. We carried out a retrospective cohort study on all pregnancies within the United States’ Health Care Cost and Utilization Project - Nationwide Inpatient Sample (HCUP- NIS) Database from 1999 - 2014. Among these women, demographic and baseline clinical risk factors were compared in individuals with and without IE and unconditional logistic regression was used to estimate the effect of risk factors on associated maternal mortality. There were 475 cases of IE among 13,219,726 deliveries from 1999-2014 in the United States (3.6 per 100,000 deliveries). As compared to women with no IE, women with IE in pregnancy tended to be older (35+), Caucasian, and reported income within the lowest quartile. Women with IE were more commonly found to have a history of prior valvular disease, congestive heart failure (CHF), rheumatic heart disease and drug abuse as compared to women with no IE. Staphylococcus species was the most commonly implicated organism, accounting for 68.6% of total cases. In women with IE in pregnancy, 11.5% underwent valve replacement surgery. Mortality with IE was 5.3% compared to .003% in all other pregnant women (p< .0001). In adjusted analyses, acute renal failure (OR 3.3, 95% CI 1.2-9.5 p=.02), acute myocardial infarction (MI) (OR 15.4, 95% CI 2.1-111.9 p=.007) and sepsis (OR 4.7, 95% CI 1.9-11.6 p< .001) were all associated with a significantly increased risk of death. IE in pregnancy is rare but it is associated with an increased risk of maternal morbidity and mortality. Pregnancies with suspected IE should be transferred to centers capable of providing cardiac surgery and intensive care.

Инфекционный эндокардит при беременности

Инфекционный эндокардит при беременности

Management of Acute Aortic Infective Endocarditis in Pregnancy

The reported incidence of infective endocarditis during pregnancy is 0,006% and there are no accepted guidelines. Management is individually based according to gestational age and the status of the mother. A multidisciplinary approach is required. Cardiopulmonary bypass, hypothermia and hyperkalemia may be fatal for the foetus due to vasoconstrictive response of the uteroplacental arteries. Herein, we report a case of successful treatment of acute aortic endocarditis during the second trimester of gestation, with a focus on timing of surgery and technical aspects. Keywords: Pregnancy, valve, endocarditis, cardiopulmonary bypass. Read more →

Endocarditis in pregnancy: a case report

Endocarditis in pregnancy: a case report

Infectious endocarditis during pregnancy, problems in the decision-making process: a case report

Infective endocarditis in pregnancy has a low incidence, often being associated with a previous history of rheumatic or congenital heart disease. In most reports the disease tends to run a subacute course and to appear more frequently in the third trimester of pregnancy. We present the case of a 36-year-old woman with large vegetations on the mitral valve due to infective endocarditis detected at the 32nd week of her first pregnancy. The difficulties in selecting the appropriate management strategy, particularly optimal time and mode of delivery, optimal time and type of valve surgery, are emphasized.

Management of Infective Endocarditis in Pregnancy

EDITORIAL COMMENT: : We accepted this paper for publication to remind readers that bacterial endocarditis can occur in pregnancy and requires prompt diagnosis and treatment for favourable results. Fever and/or urinary symptoms should suggest the diagnosis especially when the women is known to have a cardiac murmur. We were interested to read how echocardiography can reveal the presence of vegetations on affected valves. Our cardiologist reviewer was not 100% convinced that the diagnosis was proven in Case 1 since ‘many patients would have bacteraemic episodes with a known cardiac lesion which does not necessarily go on to produce endocarditis’. Our reviewer considered the diagnosis in Case 2 to be clear-cut, but was surprised how successful antibiotic therapy alone was in view of the evidence of peripheral embolization.

Bacterial endocarditis in pregnancy: Successful surgical correction

Bacterial endocarditis, an extremely rare and serious complication during pregnancy, is almost always fatal to the fetus. This paper describes successful aortic valve replacement in a woman who was 22 weeks' pregnant. She had acute bacterial endocarditis with aortic insufficiency and severe congestive heart failure. At term, she was delivered of a live infant. We believe this is the first case of a fetus surviving such a complication.

Bacterial endocarditis in pregnancy.

Summary: Five cases of bacterial endocarditis associated with pregnancy are described. Despite modern therapy, the seriousness of the condition prevails. Emergency valve replacement during the acute stage of the disease is now possible.

A FATAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS IN PREGNANCY

A FATAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS IN PREGNANCY

Streptococcus viridans endocarditis in pregnancy: With three case reports

There have been 15 proved cases of Streptococcus viridans endocarditis reported in pregnancy, to which we have added 3 case reports. The disease may be easily mistaken for pyelonephritis or puerperal sepsis at the onset but is readily differentiated by culture of the blood, examination of the heart, and careful search for embolic phenomena. While all of the mothers have died, 10 out of 12 viable infants born have survived. Transient bacteriemias in the fetus have been noted twice, but the infection is easily overcome. Interference with the pregnancy or operative delivery is not advisable, and efforts should be made to carry the fetus to viability.