Role of bacterial pathogens and toxins in sepsis-related myocardial injury: a scoping review.

Abstract

To map and synthesise human and experimental literature examining associations between specific bacterial pathogens or toxins and myocardial injury in adult sepsis and to evaluate whether the available evidence supports pathogen-specific mechanisms of myocardial injury. Scoping review conducted in accordance with the Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. MEDLINE (via PubMed), Embase and Web of Science were searched from inception to December 2024, with an updated search in December 2025. Two reviewers independently screened studies for eligibility and reference lists of relevant articles were searched. Studies of adults (≥18 years) with sepsis, experimentally induced bacteraemia or experimentally induced endotoxaemia were included if they reported myocardial injury associated with microbiologically identified bacterial pathogens and/or specific toxins. Myocardial injury was defined by circulating cardiac biomarkers and/or histopathological evidence. Animal-only studies were excluded. Only studies published in English were included. Two reviewers independently extracted data using a predefined data extraction form. Findings were synthesised descriptively according to pathogen, study design, methods used to identify myocardial injury and reported cardiac findings. 17 studies met the inclusion criteria, comprising 173 clinical patients from three observational cohort studies and 13 case reports, together with one experimental in vitro study of 23 ex vivo human myocardial tissue samples. A diverse range of Gram-negative and Gram-positive pathogens was reported. Myocardial injury was identified predominantly by circulating biomarkers, with limited postmortem histopathological confirmation. No study was designed to evaluate causal or comparative pathogen-specific mechanisms. Across studies, myocardial injury occurred in heterogeneous infectious contexts without consistent association with specific bacterial species or toxins. Human evidence linking specific bacterial pathogens or toxins to myocardial injury in sepsis is limited and largely descriptive. Available data do not demonstrate consistent associations between specific bacterial pathogens or toxins and myocardial injury, nor do they permit mechanistic attribution. Open Science Framework, https://osf.io/e3pnc/overview.