ESTATINAS E INFECCIÓN POR C. DIFFICILE

STATINS DECREASE THE RISK FOR CLOSTRIDIUM DIFFICILE–ASSOCIATED DIARRHEA IN HOSPITALS

Preliminary evidence of another beneficial effect of statins

Use of antibiotics or proton-pump inhibitors is associated with an increased risk for Clostridium difficile–associated diarrhea (CDAD). Statin use is associated with reduced risk for certain types of infections — most likely because of the drugs' anti-inflammatory properties — but its possible protective effect on healthcare-facility (HCF)–onset CDAD has not been specifically examined until now.

In a large case-control study, investigators assessed statin use in a network of U.S. academic health centers in 31,472 adult patients who developed CDAD during hospitalization (cases) and in 78,096 matched controls. Cases were identified with previously validated criteria of a diagnosis of diarrhea during hospitalization and treatment with metronidazole or oral vancomycin for 3 days on or after day 5 of hospitalization. Controls were hospitalized for 8 days and were matched to cases by age, hospital, year, and quarter.

Use of any statin was associated with a 22% reduction in risk for HCF-onset CDAD. Use of each individual statin (simvastatin, lovastatin, atorvastatin, and pravastatin) was also associated with a risk reduction, providing evidence of a class effect. Other cholesterol-lowering medications had no apparent effect on risk for HCF-onset CDAD.

Gut 2012;61:1538-1542 

STATIN USE AND THE RISK OF CLOSTRIDIUM DIFFICILE IN ACADEMIC MEDICAL CENTRES

Christine Anne Motzkus-Feagans, Amy Pakyz, Ronald Polk, Giovanni Gambassi, Kate L Lapane^.

Abstract

Objectives To estimate the possible relationship between statin use and the risk of healthcare facility onset Clostridium difficile.

Methods Patients over 18 years of age admitted to hospitals contributing data to the University HealthSystem Consortium between 2002 and 2009 were eligible. Patients with the ICD-9-CM code 008.45 who received a minimum 3-day course of either metronidazole or oral vancomycin on/after day 5 of admission were considered incident cases of C difficileinfection. 31 472 incident cases of C difficile infection were identified and matched to five controls, on hospital, year/quarter of admission date, and age ±10 years (N=78 096). Patients who were administered one drug in the statin class (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin) before the index date were considered to be exposed. Conditional logistic regression modelling provided adjusted odds ratios and 95% CI.

Results Compared with non-users, users of any drug within the statin class were 0.78 times less likely to develop C difficile infection in the hospital (95% CI 0.75 to 0.81) adjusting for potential confounders. Differences in estimates for specific statins were minimal. Niacin, fibrates and selective cholesterol absorption inhibitors showed no association with the risk ofC difficile infection.

Conclusions Our data were consistent with a growing body of literature demonstrating a reduced risk of infections with statin use. Statins' pleiotropic properties may provide protection against C difficile infection.