Evidence To Support Continuation of Statin Therapy in Patients with Staphylococcus aureus Bacteremia

Abstract

In addition to cholesterol-lowering capabilities, statins possess antiinflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes in Staphylococcus aureus bacteremia. We conducted a retrospective cohort study among hospitalized patients with positive S. aureus blood cultures receiving appropriate antibiotics within 48 h of culture collection (Veterans Affairs hospitals, 2002 to 2013). Three statin exposure groups were compared to nonusers: pretreated statin users initiating therapy in the 30 days prior to culture and either (i) continuing statin therapy after culture or (ii) not continuing after culture, and (iii) de novo users initiating at culture. Nonusers included patients without statins in the year prior to culture through discharge. Propensity score-matched Cox proportional hazards regression models were developed. We were able to balance significantly different baseline characteristics using propensity score matching for pretreated without continuation (n ϭ 331), pretreated with continuation (n ϭ 141), and de novo (n ϭ 177) statin users compared to nonusers. We observed a significantly lower 30-day mortality rate (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.25 to 0.84; number needed to treat [NNT], 10) among pretreated and continued statin users, while protective effects were not observed in de novo (HR, 1.04; 95% CI, 0.60 to 1.82; NNT, undefined) or pretreated but not continued (HR, 0.92; 95% CI, 0.64 to 1.32; NNT, 47) users. In our national cohort study among patients with S. aureus bacteremia, continuation of statin therapy among incident statin users was associated with significant beneficial effects on mortality, including a 54% lower 30-day mortality rate.

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“…Obtaining 42% of the isolates in blood samples is alarming because S. aureus bacteremia is associated with high case fatality (20-30%) [19]. All the isolates were penicillin-resistant and sensible to vancomycin, quinupristin/dalfopristin and linezolid (Table 1).…”

Association of Higher Daptomycin Dose (7 mg/kg or Greater) with Improved Survival in Patients with Methicillin‐Resistant Staphylococcus aureus Bacteremia

“…Clinical data were obtained from the national VA electronic health database that includes International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnostic and procedure codes, chemistry and microbiology data, vital signs, and pharmacy data including bar code medication administration records . This study was approved by the institutional review board and Research and Development Committee of the Providence VA Medical Center.…”

Statins Improve the Long-term Survival in the Survived Sepsis Patients, a Nationwide Cohort Study in Taiwan

“…In a national cohort study by Caffrey et al, it demonstrated in detail that among the patients with Staphylococcus aureus bacteremia, the continuation of statin therapy among pretreated statin users was associated with significant beneficial effects on 30-day hospital mortality, but not in de novo statin users or in pretreated statin users who did not continue statin therapy after admission. [ 17 ] From these studies, it was reasonable to infer that statin therapy should continue for a period up to an effective cumulative dose to exert its protective effects in sepsis. And this is relatively consistent with our study that the protective effect of statins was positively proportional to the cDDDs.…”