Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease are Serotype Dependent.

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 CAP patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exists 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; 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 (OR 1, 48; 95% CI [1.21-2.27]; p=0.013) and serotype 9n (OR 1.29; 95% CI [1.08-2.24]; p=0.020). 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 [SD], 138 [145] versus 73 [106], p=0.01).

CONCLUSIONS: MACE are common during IPD with serotype 3 and 9n independently of frequency.