Streptococcus pneumoniae infection is an independent cause of cardiac rhythm alteration in community-acquired pneumonia

Background: Streptococcus pneumoniae (Pneumococcus) was recently associated with the development of cardiac microlesions, cardiac dysfunction, and tachyarrhythmia (TA). Limited data are available regarding the translation of these findings in clinical practice. Our aims were twofold: 1) assess the association of pneumococcus and tachycardia in patients with community acquired pneumonia (CAP) and 2) determine if TA is associated with a poor prognosis among patients with CAP.Methods: From a prospective multicenter cohort, CAP patients were stratified in TA (heart rateu003e100/min). We performed a multivariate analysis using the heart rate stratification as the dependent variable.Results: We identified 646 (30.4%) cases of TA among 2,123 hospitalized CAP patients. Pneumococcal pneumonia (OR 1.46; 95%CI 1.14-1.88, p=0.003) and diabetes (OR 1.32; 95%CI 1.06-1.62, p=0.015) were independently associated with TA.CAP patients who developed TA were more likely to present hypoxemia (OR 1.38; 95%CI 1.03-1.86, p=0.031), ICU admission (OR 1.75, 95%CI 1.05-2.93, p=0.033), have longer length of hospital stay (10.7 vs. 8.1 days, p=0.001) and increased hospital mortality (OR 1.89, 95%CI 1.09-3.24, p=0.023) compared to normal heart rate.Conclusions: Tachyarrhythmias were identified in one third of the patients with CAP and were associated with poor clinical outcomes. Pneumococcus was independently associated with tachyarrhythmia in CAP patients. Further studies should address the mechanisms associated with the development of cardiac injury among patients with CAP due to pneumococcus and other pathogens.