Pneumococcal Aortitis Requires Multidisciplinary Approach to Improve Mortality Rates

With high mortality risks persistent across impacted populations, the management of pneumococcal aortitis requires an updated multidisciplinary approach to improve patient outcomes, according to a Clinical Infection in Practice study.¹

“Infectious aortitis is a rare but serious condition that can lead to catastrophic vascular events such as aortic rupture or dissection, septic embolization, or fatal hemorrhage or sepsis,” wrote the authors of the study. “The estimated mortality rate reaches 90% without surgical intervention but decreases to approximately 40% when managed with a combination of surgery and prolonged antibiotic therapy.”

Pneumococcal aortitis remains a rare but devastating manifestation of invasive pneumococcal disease (IPD), characterized by the inflammation and destruction of the aortic wall, which frequently culminates in the formation of life-threatening mycotic aneurysms.¹ Although the overall incidence of invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs), mortality rates for those who develop acute complications have remained stubbornly unchanged over the last several decades.²

READ MORE: Pneumococcal Vaccination Significantly Reduces IPD Mortality

For the clinical pharmacist, this necessitates a high index of suspicion and a deep understanding of the evolving diagnostic and therapeutic landscape to manage these high-risk patients effectively.

The Common Complications Surrounding Pneumococcal Aortitis

The diagnostic challenge of pneumococcal aortitis lies in its nonspecific and often “insidious”—as some researchers have put it—clinical presentation, which can range from unexplained fever and weight loss to acute abdominal or back pain.^1,3 Because Streptococcus pneumoniae is exquisitely sensitive to antimicrobials, traditional blood cultures are positive in only about 49% of cases, often becoming sterile after even a single dose of an antibiotic.¹ This frequently leads to diagnostic delays that can be fatal.

Modern management now increasingly relies on advanced molecular techniques, such as 16S PCR and metagenomic next-generation sequencing (mNGS), which can identify bacterial DNA in blood or aortic tissue even when cultures remain negative. In one case, a diagnosis of periaortitis was confirmed only after a Karius test identified microbial, cell-free DNA when all other cultures had failed.⁴

Pharmacists must also consider the broader cardiovascular context of IPD, as roughly 4.2% of patients experience a major cardiovascular event within one year of admission. Research indicates that alcohol abuse is a significant independent predictor for acute coronary syndromes following IPD, according to the International Journal of Infectious Diseases (IJID).⁵

Furthermore, specific pneumococcal serotypes, such as 7F and 19A, have been associated with increased disease severity and higher risks of cardiovascular complications.^2,5 These patients often present with multiple comorbidities, most notably atherosclerosis, which structurally compromises the intimal layer of the aorta and makes it more susceptible to bacterial seeding.¹

“In this study, in 4.2% of patients with IPD, a cardiovascular event (CVE) was reported within 1 year after admission. Alcohol abuse was the sole independent predictor for ACS, whereas high fever was for stroke,” wrote the authors of the IJID study.⁵ “Pneumococcal serotypes were pronounced predictors for CVE in younger adult patients. We found no evidence that the choice of antibiotic treatment contributes to the development of CVE.”

Pharmacist Management of Pneumococcal Aortitis

The therapeutic management of pneumococcal aortitis requires a robust, multidisciplinary team including infectious disease experts, cardiothoracic surgeons, and pharmacists to navigate the complexities of long-term care.^1,3 Surgical debridement is typically paired with a minimum of 6 to 12 weeks of intravenous antibiotic therapy, and in cases involving prosthetic material, lifelong antimicrobial suppression may be considered.¹

Pharmacists play a vital role in this phase, monitoring for drug-related complications such as QT prolongation associated with macrolides or fluoroquinolones, particularly in older patients with pre-existing heart disease.⁵ Beyond the acute phase, patients with IPD face an all-cause mortality rate nearly 3 times higher than the general population, emphasizing the need for comprehensive long-term care and secondary prevention strategies, including aggressive management of hypertension, cholesterol, and tobacco cessation.^2,3

Ultimately, reducing the high mortality of this condition depends on early recognition, the use of sophisticated molecular diagnostics, and the seamless coordination of the entire health care team.^1,4 On top of a more coordinated approach across health care sectors, experts also agree a slew of new research is needed to advance management techniques.

“There is an urgent need for prospective, multicenter epidemiological studies integrating standardized, comprehensive clinical and microbiological data,” concluded the authors of the current study.¹ “These studies should aim to better define risk factors, characterize the pathophysiology of pneumococcal aortitis, validate the role of molecular diagnostics, and optimize management strategies.”

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Sandoz E, Lorenzi-Tognon MD, Tittel-Elmer M, et al. Pneumococcal aortitis: a rare but severe and often undiagnosed vascular complication. Clin Infect Pract. February 26, 2026:100621. https://doi.org/10.1016/j.clinpr.2026.100621

2. Bragason HT, Rögnvaldsson KG, Hernandez UB, et al. Disease trends and mortality from invasive pneumococcal disease: a long-term population-based study. CID. December 5, 2025. https://doi.org/10.1093/cid/ciaf670

3. Aortitis (inflammatory aortic disease): causes, symptoms & treatment. Cleveland Clinic. October 3, 2022. Accessed March 9, 2026. https://my.clevelandclinic.org/health/diseases/24264-aortitis

4. El Hasbani G, Wilson J, Warrington K. A case of pneumococcal periaortitis: Periaortitis is not always autoimmune. EJCRIM. 2025;12(8). https://doi.org/10.12890/2025_005633

5. Dulfer EA, Serbée MJV, Dirkx KKT, et al. Cardiovascular events after invasive pneumococcal disease: a retrospective cohort study. IJID. 2024;147:107185-107185. https://doi.org/10.1016/j.ijid.2024.107185