36 - Maternity-associated Infective Endocarditis in the United States: Similar Outcomes to Non-pregnant Patients

Background: Little is known about infective endocarditis (IE) occurring during pregnancy. In this analysis, we sought to define the patient characteristics, risk factors, and outcome of maternity-associated IE (maIE).

Methods: The National Readmissions Database was used to identify admissions for IE in female patients aged 12 – 55 years discharged between Oct. 2015 and Dec. 2017. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regressions adjusted for demographics, hospital, etiologic organism, and comorbid conditions to assess the association between maternity status and outcomes.

Results: Out of 10,271 identified IE admissions (corresponding to a national estimate of 19,626 admissions), maIE accounted for 320 (national estimate 617) (3.1%). Of these maIE admissions, 41.2% were antepartum admissions, 26.3% resulted in delivery, 18.3% were postpartum, and 11.3% were an early or abnormal pregnancy. Patients with maIE were younger (28.4 ± 3.9 vs. 36.6 ± 8.0, P < 0.001) and more likely insured by Medicaid (73.3% vs. 46.6%, P < 0.001). Although generally healthier, patients with maIE had higher rates of drug abuse (75.7% vs. 58.5%, P < 0.001). In unadjusted comparisons maIE was associated with lower rates of 60-day mortality and thromboembolic events. In adjusted analysis only differences between rates of thromboembolic events were significant (adjusted incremental difference: -17.1%, 95% confidence interval: -22.7% to -11.6%). Differences in rates of valve procedures, mechanical ventilation, length of stay, and inpatient costs were not statistically significant (Figure).Regression-adjusted Outcomes


Conclusion: Compared with other reproductive aged female IE patients, patients with maIE are younger, healthier, more likely insured by Medicaid, and report higher rates of drug abuse. After adjustment, they receive similar management and do not appear to be at higher risk for adverse outcomes including mortality.

Presenting Author(s)

• 

  Michael M. Dagher, MD

  Research Scholar
  Duke University Medical Center
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• 

  Emily Eichenberger, MD

  Infectious Disease Fellow
  Duke University
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KA

  Kateena L. Addae-Konadu, MD, PhD, MSc

  Maternal Fetal Medicine Clinical Fellow
  Duke University Medical Center
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SD

  Sarah K. Dotters-Katz, MD, MSHPE

  Assistant Professor of Obstetrics and Gynecology
  Duke University Medical Center
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Vance G. Fowler, Jr., MD, MHS

  Professor of Medicine
  Duke University
  Durham, North Carolina

  Disclosure: Abbvie : Grant/Research Support (Status: Ongoing); Actavis : Grant/Research Support; Advanced Liquid Logics : Grant/Research Support; Affinergy : Consultant, Research Grant or Support; Affinium : Consultant; Allergan : Grant/Research Support; Ampliphi Biosciences : Consultant; Armata : Consultant (Status: Ongoing); Basilea : Consultant, Research Grant or Support; Bayer : Consultant, Consultant; C3J : Consultant; CARB-X : Consultant (Status: Ongoing); Cerexa : Consultant, Research Grant or Support; Contrafect : Consultant, Research Grant or Support; Cubist : Grant/Research Support; Debiopharm : Consultant; Destiny : Consultant; Durata : Consultant; Forest : Grant/Research Support; Genentech : Consultant, Research Grant or Support; ICBiome : Consultant (Status: Ongoing); Integrated Biotherapeutics : Consultant; Janssen : Consultant, Research Grant or Support; Karius : Grant/Research Support; Locus : Grant/Research Support; Medical Biosurfaces : Grant/Research Support; Medicines Co. : Consultant; Medimmune : Consultant, Research Grant or Support; Merck : Consultant, Research Grant or Support; NIH : Grant/Research Support; Novadigm : Consultant; Novartis : Consultant, Research Grant or Support; Pfizer : Grant/Research Support; Regeneron : Consultant, Research Grant or Support; Tetraphase : Consultant; Theravance : Consultant, Research Grant or Support; Valanbio : Board Member (Status: Ongoing), Other Financial or Material Support (Status: Ongoing), Stock options (Status: Ongoing); xBiotech : Consultant
• JF

  Jerome Federspiel, MD, PhD

  Maternal Fetal Medicine Fellow in Training
  Duke University Medical Center
  Durham, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.