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Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease Are Serotype Dependent
Hector F Africano1, Cristian C Serrano-Mayorga1, Paula C Ramirez-Valbuena1
1Universidad de la Sabana, Chía, Colombia.
Background:
Up to 30% of patients admitted to hospitals with invasive pneumococcal disease (IPD) experience major adverse cardiovascular event (MACE) including new/worsening heart failure, new/worsening arrhythmia, and/or myocardial infarction. Streptococcus pneumoniae (Spn) is the most frequently isolated bacterial pathogen among community-acquired pneumonia (CAP) patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exist identifying which serotypes of Spn are principally responsible for MACE.
Methods:
This was an observational multicenter retrospective study conducted through the Public Health Secretary of Bogotá, Colombia. We included patients with a confirmed clinical diagnosis of IPD with record of pneumococcal serotyping and clinical information between 2012 and 2019. Spn were serotyped using the quellung method by the National Center of Microbiology. MACE were determined by a retrospective chart review.
Results:
The prevalence of MACE was 23% (71/310) in IPD patients and 28% (53/181) in patients admitted for CAP. The most prevalent S. pneumoniae serotype identified in our study was the 19A, responsible for the 13% (42/310) of IPD in our cohort, of which 21% (9/42) presented MACE. Serotypes independently associated with MACE in IPD patients were serotype 3 (odds ratio [OR] 1, 48; 95% confidence interval [CI] [1.21-2.27]; P = .013) and serotype 9n (OR 1.29; 95% CI [1.08-2.24]; P = .020). Bacteremia occurred in 87% of patients with MACE. Moreover, serum concentrations of C-reactive protein were elevated in patients with MACE versus in non-MACE patients (mean [standard deviation], 138 [145] vs 73 [106], P = .01).
Conclusions:
MACE are common during IPD with serotype 3 and 9n independently of frequency.
Insights
Major adverse cardiovascular events (MACE) are common in invasive pneumococcal disease (IPD). Serotypes 3 and 9n of Streptococcus pneumoniae are independently linked to MACE, regardless of their prevalence.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Invasive pneumococcal disease (IPD) affects up to 30% of hospitalized patients, leading to major adverse cardiovascular events (MACE).
- Streptococcus pneumoniae (Spn) is a key pathogen in community-acquired pneumonia (CAP) and is independently associated with MACE.
- Specific Spn serotypes responsible for MACE remain unidentified in clinical settings.
Purpose of the Study:
- To identify specific Streptococcus pneumoniae serotypes associated with major adverse cardiovascular events (MACE) in patients with invasive pneumococcal disease (IPD).
- To investigate the clinical characteristics and prevalence of MACE in IPD patients.
Main Methods:
- An observational, multicenter, retrospective study was conducted in Bogotá, Colombia, from 2012 to 2019.
- Patients with confirmed IPD and available pneumococcal serotyping data were included.
- Pneumococcal serotypes were determined using the quellung method, and MACE were identified through retrospective chart review.
Main Results:
- The prevalence of MACE was 23% in IPD patients and 28% in CAP patients.
- Serotype 19A was the most prevalent Spn serotype (13%), with 21% of these patients experiencing MACE.
- Serotypes 3 (OR 1.48) and 9n (OR 1.29) were independently associated with MACE in IPD patients.
- Bacteremia was present in 87% of MACE patients, and elevated C-reactive protein levels were observed in MACE patients.
Conclusions:
- Major adverse cardiovascular events (MACE) are a significant complication of invasive pneumococcal disease (IPD).
- Streptococcus pneumoniae serotypes 3 and 9n are independently associated with MACE in IPD patients, irrespective of their frequency.
- These findings highlight specific serotypes as critical risk factors for cardiovascular complications in IPD.
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