(A-298) Clinical Characteristics and In-Hospital Outcomes of Infective Endocarditis Among Pregnant Women with Substance Use Disorders: A Nationwide Analysis

Background: Infective endocarditis (IE) is a severe complication of substance use disorders (SUD), with limited data on recent hospitalization trends, clinical characteristics, and outcomes in pregnant women.

Objectives: This study aimed to evaluate clinical characteristics and in-hospital outcomes among pregnant women with IE related to SUD using a nationwide database.

Methods: This retrospective cross-sectional analysis used the Vizient® Clinical Data Base years 2016–2023 (data used with permission of Vizient, Inc., all rights reserved) to identify pregnancy-related hospitalizations with IE associated SUD in the United States. Trends in IE hospitalization and mortality were analyzed using the Cochrane-Armitage Test. A 1:5 age-matched cohort (pregnant vs non-pregnant women) was created to compare the in-hospital outcomes. The primary outcome was in-hospital mortality. The secondary outcomes included valvular surgery and length of hospital stay.

Results: During the study period, we identified 630 pregnant women with IE associated SUD. The mean age was 30.2 years, predominantly White (86.3%), and insured by Medicaid (86.7%). Staphylococcus species was the most commonly occurring pathogen (59.8%). IE hospitalizations among pregnant women with SUD remained unchanged from 26.1 per 100,000 pregnancy-related hospitalization in 2016 vs 27.7 per 100,000 pregnancy-related hospitalizations in 2023 (P < 0.0001). In-hospital mortality among pregnant women with IE associated SUD did not largely change (5.4% in 2016 vs 4.3% in 2023, P=0.11). We identified an age-matched cohort of 3,150 non-pregnant women with IE associated SUD. With respect to the study outcomes among pregnant vs. non-pregnant women with IE associated SUD; there was no difference in the incidence of in-hospital mortality (6.0% vs 5.7%, P=0.75) or valvular surgery (12.5% vs 14.4%, P=0.21). Pregnant women had a longer mean hospital stay as compared to non-pregnant women (24.7 + 21.0 days vs. 18.8 + 20.4 days, P< 0.001).

Conclusions: This nationwide analysis indicates that IE associated with SUD presents a significant burden among pregnant women, with no notable decline in trends observed. The relationship between IE and SUD is linked to considerable mortality and morbidity. Urgent interventions are needed to lessen the burden of IE associated with SUD among pregnant women. Clinically, enhanced monitoring and multidisciplinary management are essential for improving in-hospital outcomes among pregnant women. From a research perspective, further studies should investigate the factors contributing to hospitalization trends and evaluate targeted interventions.