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

Abstract

Background: Endocarditis during pregnancy carries a maternal mortality of up to 30%, but prior publications do not reflect the current opioid epidemic.

Case presentations: We reviewed our institution's infective endocarditis registry from 2009 to 2019 and identified 19 females with endocarditis during pregnancy in order to compare our contemporary outcomes with historical reports. In our cohort, intravenous drug use was reported in all cases, and the most common pathogen was Staphylococcus (74%) followed by Serratia (13%). The tricuspid valve was involved in 18 (95%) patients, and contrary to prior reports, all but two patients were managed conservatively with antibiotics alone. Maternal and infant mortality (5% and 0%, respectively) were lower in our cohort compared to all previous reviews.

Conclusion: We conclude that the better outcomes seen in this report are likely due to the younger age of the patients and the more frequent right-sided valvular involvement.

Summary: This review highlights contemporary outcomes in endocarditis during pregnancy. We review historical case reports in light of the opioid epidemic. We observed more Staphylococcus, more right-sided valvular involvement, and more conservative management as well as improved maternal and foetal mortality.

Keywords: Infective endocarditis; intravenous drug use; opioid use; pregnancy.