Maternal and Fetal Outcomes Associated With Infective Endocarditis in Pregnancy.

Abstract

Background

Infective endocarditis (IE) is a rare but serious infection that complicates pregnancy. Little is known about IE management and outcomes in this population.

Methods

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.

Results

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).

Conclusions

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1093/cid/ciab533

Publication Info

Dagher, Michael M, Emily M Eichenberger, Kateena L Addae-Konadu, Sarah K Dotters-Katz, Celia L Kohler, Vance G Fowler and Jerome J Federspiel (2021). Maternal and Fetal Outcomes Associated With Infective Endocarditis in Pregnancy. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(9). pp. 1571–1579. 10.1093/cid/ciab533 Retrieved from https://hdl.handle.net/10161/24325.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Dotters-Katz

Sarah K. Dotters-Katz

Associate Professor of Obstetrics and Gynecology

My passion is for medical education. As a resident, I was recognized for excellence in teaching by the medical students during all four years of my training, and completed the “Resident as Teacher” program during that time as well. I have obtained my Masters of Medical Health Professions Education from Eastern Virginia Medical School from 2016-2017. During that time, I also completed the University of North Carolina Faculty Scholars program and was inducted into the University of North Carolina’s Academy of Educators. My passion for teaching was recognized by medical students and residents alike at UNC, receiving teaching awards from both medical students and residents. In coming to Duke in 2017, I joined the Division of Education as the Assistant Director of Undergraduate Medical Education. I now serve as the Director of Undergraduate Medical Education, where I have the opportunity to work with medical students, physician assistant students and nurse practitioner students on a regular basis as well as help our faculty and residents become better teachers. I am proud and excited to continue to bring energy and enthusiasm for teaching to Duke and help inspire learners to love Obstetrics and Gynecology as much as I do.  

Fowler

Vance Garrison Fowler

Florence McAlister Distinguished Professor of Medicine

Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia
Antibacterial Resistance
Pathogenesis of Bacterial Infections
Tropical medicine/International Health

Federspiel

Jerome Jeffrey Federspiel

Assistant Professor of Obstetrics and Gynecology

Dr. Federspiel is a maternal fetal medicine physician at Duke University. His clinical and research interests focus on the care of people with cardiovascular and hematologic complications of pregnancy.


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