The Effects of Statins on C difficile Infection
The Effects of Statins on C difficile Infection
Background An association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.
Aim To determine the clinical characteristics and treatment outcomes of Clostridium difficile infection (CDI) among hospitalised patients taking statin drugs.
Methods The medical records were reviewed for consecutive in-patients with CDI confirmed by positive toxin assay (A or B), C. difficile culture, or the presence of pseudomembrane on endoscopy. Treatment success was defined as the resolution of diarrhoea within 6 days of therapy. The primary end points were assessed by average symptom recovery time and treatment response (success or failure).
Results Among 949 patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between statin users and statin non-users with respect to mean disease severity score. In the multivariate analysis, successful treatment response was significantly associated with the absence of exposure to proton pump inhibitors (PPIs) (OR = 0.690, 95% CI = 0.513–0.929, P = 0.014) and with exposure to statins (OR = 1.449, 95% CI = 1.015–2.070, P = 0.041). Contrary to the treatment response, univariate and multivariate analyses failed to show that exposure to PPIs or statins affected symptom recovery times. Sixty-day CDI recurrence rates for those patients with statin exposure were significantly lower compared with those patients without statin exposure (3% vs. 7.3%, respectively; RR = 0.393, 95% CI = 0.167–0.926, P = 0.033).
Conclusion Prior statin exposure in patients with C. difficile infection is associated with a successful response to treatment.
Clostridium difficile (C. difficile) has been implicated in up to 25% of antibiotic-associated diarrhoea and nearly all bacterial cases of hospital-acquired diarrhoea. The spectrum of disease can range from uncomplicated diarrhoea to pseudomembranous colitis, toxic megacolon, sepsis with associated organ failure and even death. C. difficile is now occurring more commonly in younger patients who are relatively healthy and may not be receiving antibiotics. Co-factors that might explain the increased incidence and changing demographics of C. difficile infection are of great public health interest. The increased incidence of C. difficile infection (CDI) may be attributed in part to the broad usage of proton pump inhibitors (PPIs). By mechanisms which are not entirely clear, recent investigations have identified gastric acid suppression, particularly via PPIs, as a risk factor for the development of CDI. Furthermore, a statistically significant increase in CDI was observed in antibiotic recipients who took PPIs. Other studies also identified a significant association between PPI use and higher recurrence rates of CDI.
Contrary to the studies about PPIs and CDI, one intriguing study recently found that the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) decreases the incidence and risk of healthcare facility-onset CDI. Statins are typically the treatment of choice for the majority of patients with dyslipidaemia, although several studies have also shown favourable effects of statin therapy on outcomes in patients with various infections. The clinical use of statins for infections (such as pneumonia or sepsis) is likely secondary to their immune-modulatory effects and pleiotropic properties against inflammation. In fact, the majority of clinical trials have demonstrated beneficial effects of statins for sepsis, pneumonia and viral infections. The overall mortality or risk of infection is decreased in statin users compared with statin non-users. In a large observational cohort study, in-patient treatment with statins was associated with a modest reduction in pneumonia mortality outside the intensive care unit. Furthermore, statins reduced the mortality of patients with bacteraemia, particularly with long-term statin use prior to the bacteraemia.
On the basis of these results and because there are few studies investigating the effects of statin use in patients with CDI, a retrospective study was performed to assess the clinical characteristics and treatment outcomes of CDI in patients taking statins.
Abstract and Introduction
Abstract
Background An association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.
Aim To determine the clinical characteristics and treatment outcomes of Clostridium difficile infection (CDI) among hospitalised patients taking statin drugs.
Methods The medical records were reviewed for consecutive in-patients with CDI confirmed by positive toxin assay (A or B), C. difficile culture, or the presence of pseudomembrane on endoscopy. Treatment success was defined as the resolution of diarrhoea within 6 days of therapy. The primary end points were assessed by average symptom recovery time and treatment response (success or failure).
Results Among 949 patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between statin users and statin non-users with respect to mean disease severity score. In the multivariate analysis, successful treatment response was significantly associated with the absence of exposure to proton pump inhibitors (PPIs) (OR = 0.690, 95% CI = 0.513–0.929, P = 0.014) and with exposure to statins (OR = 1.449, 95% CI = 1.015–2.070, P = 0.041). Contrary to the treatment response, univariate and multivariate analyses failed to show that exposure to PPIs or statins affected symptom recovery times. Sixty-day CDI recurrence rates for those patients with statin exposure were significantly lower compared with those patients without statin exposure (3% vs. 7.3%, respectively; RR = 0.393, 95% CI = 0.167–0.926, P = 0.033).
Conclusion Prior statin exposure in patients with C. difficile infection is associated with a successful response to treatment.
Introduction
Clostridium difficile (C. difficile) has been implicated in up to 25% of antibiotic-associated diarrhoea and nearly all bacterial cases of hospital-acquired diarrhoea. The spectrum of disease can range from uncomplicated diarrhoea to pseudomembranous colitis, toxic megacolon, sepsis with associated organ failure and even death. C. difficile is now occurring more commonly in younger patients who are relatively healthy and may not be receiving antibiotics. Co-factors that might explain the increased incidence and changing demographics of C. difficile infection are of great public health interest. The increased incidence of C. difficile infection (CDI) may be attributed in part to the broad usage of proton pump inhibitors (PPIs). By mechanisms which are not entirely clear, recent investigations have identified gastric acid suppression, particularly via PPIs, as a risk factor for the development of CDI. Furthermore, a statistically significant increase in CDI was observed in antibiotic recipients who took PPIs. Other studies also identified a significant association between PPI use and higher recurrence rates of CDI.
Contrary to the studies about PPIs and CDI, one intriguing study recently found that the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) decreases the incidence and risk of healthcare facility-onset CDI. Statins are typically the treatment of choice for the majority of patients with dyslipidaemia, although several studies have also shown favourable effects of statin therapy on outcomes in patients with various infections. The clinical use of statins for infections (such as pneumonia or sepsis) is likely secondary to their immune-modulatory effects and pleiotropic properties against inflammation. In fact, the majority of clinical trials have demonstrated beneficial effects of statins for sepsis, pneumonia and viral infections. The overall mortality or risk of infection is decreased in statin users compared with statin non-users. In a large observational cohort study, in-patient treatment with statins was associated with a modest reduction in pneumonia mortality outside the intensive care unit. Furthermore, statins reduced the mortality of patients with bacteraemia, particularly with long-term statin use prior to the bacteraemia.
On the basis of these results and because there are few studies investigating the effects of statin use in patients with CDI, a retrospective study was performed to assess the clinical characteristics and treatment outcomes of CDI in patients taking statins.
