The effect of statins on the outcome of Clostridium difficile infection in hospitalized patients

Atamna, Alaa; Yahav, Dafna; Eliakim‐Raz, Noa; Goldberg, Elad; Ben‐Zvi, Haim; Barsheshet, Alon; Elis, Avishay; Bishara, Jihad

doi:10.1007/s10096-016-2597-9

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…91,92 A small study of patients with CDI did not find a difference in mortality, severity, or complication of CDI in statin users as compared with nonusers. 93 Proposed mechanisms for statins to protect against CDI relate to the disruption of cholesterol production. Because statins interfere with cholesterol production at the beginning of the synthesis pathway, many downstream cholesterol-independent, pleotropic effects on inflammatory, and immunomodulation pathways have been observed and studied.…”

Section: Statinsmentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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Section: Statinsmentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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“…Two additional studies evaluated the association of statins with risk of 30-day CDI mortality. 32 , 33 Meta-analysis of these 2 studies also revealed a nonsignificant result (unadjusted OR, 0.91; 95% CI, 0.34–2.39; P =0.84) ( Figure 7B ).…”

Section: Resultsmentioning

confidence: 91%

Statin use and the risk of <em>Clostridium difficile</em> infection: a systematic review with meta-analysis

Tariq

Mukhija

Gupta

et al. 2018

IDR

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PurposeStatins have pleiotropic effects beyond cholesterol lowering by immune modulation. The association of statins with primary Clostridium difficile infection (CDI) is unclear as studies have reported conflicting findings. We performed a systematic review and meta-analysis to evaluate the association between statin use and CDI.Patients and methodsWe searched MEDLINE, Embase, and Web of Science from January 1978 to December 2016 for studies assessing the association between statin use and CDI. The Newcastle–Ottawa Scale was used to assess the methodologic quality of included studies. Weighted summary estimates were calculated using generalized inverse variance with random-effects model.ResultsEight studies (6 case–control and 2 cohort) were included in the meta-analysis, which comprised 156,722 patients exposed to statins and 356,185 controls, with 34,849 total cases of CDI available in 7 studies. The rate of CDI in patients with statin use was 4.3%, compared with 7.8% in patients without statin use. An overall meta-analysis of 8 studies using the random-effects model demonstrated that statins may be associated with a decreased risk of CDI (maximally adjusted odds ratio [OR], 0.80; 95% CI, 0.66–0.97; P=0.02). There was significant heterogeneity among the studies, with an I2 of 79%. No publication bias was seen. Meta-analysis of studies that adjusted for confounders revealed no protective effect of statins (adjusted OR, 0.84; 95% CI, 0.70–1.01; P=0.06, I2=75%). However, a meta-analysis of only full-text studies using the random-effects model demonstrated a decreased risk of CDI with the use of statins (OR 0.77; 95% CI, 0.61–0.99; P=0.04, I2=85%).ConclusionMeta-analyses of existing studies suggest that patients prescribed a statin may be at decreased risk for CDI. The results must be interpreted with caution given the significant heterogeneity and lack of benefit on analysis of studies that adjusted for confounders.

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“…Lastly, a retrospective study of 178 statin users and 321 statin non-users also saw a benefit in statin use in terms of 30-day mortality, as their multivariate analysis found that statin users were more likely to survive than non-users (OR 1.54), though the results were not significant (95% CI 0.850–2.789, p = 0.392). [20, 21]…”

Section: Discussionmentioning

confidence: 99%

A possible association between statin use and improved Clostridioides difficile infection mortality in veterans

et al. 2019

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Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea and places a significant burden on patients and the health care system. Statins could lead to improvements in CDI clinical response due their pleiotropic effects, including immunomodulatory and lipid-lowering effects; however, few studies have assessed this association. The primary objective of this study was to compare CDI health outcomes in statin users and non-users in a national cohort of patients. This was a retrospective cohort study of all adult CDI patients receiving care from the Veterans Health Administration from 2002 to 2014. Patients were divided into two groups based on statin exposure 90 days prior to and during their first CDI encounter. CDI health outcomes, including mortality and CDI recurrence, were compared using a propensity-score matched cohort of statin users and non-users and multivariable logistic regression. A total of 26,149 patients met study inclusion criteria, of which 173 statins-users and 173 non-users were propensity score matched. Thirty-day mortality was significantly lower among statins users with CDI (12.7%) compared to non-users (20.2%) (aOR 0.34; 95% CI 0.16–0.72). Sixty-day CDI recurrence was non-significantly lower among statin-users (9.0%) compared to non-users (16.6%) (aOR 0.68; 95% CI 0.29–1.59). In this nationally-representative study of veterans with CDI, statin use was associated with lower 30-day mortality compared to non-use. Statin use was not associated with 60-day CDI recurrence.

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The effect of statins on the outcome of Clostridium difficile infection in hospitalized patients

Cited by 12 publications

References 24 publications

Clostridium difficile Infection: An Epidemiology Update

Clostridium difficile Infection: An Epidemiology Update

Statin use and the risk of <em>Clostridium difficile</em> infection: a systematic review with meta-analysis

A possible association between statin use and improved Clostridioides difficile infection mortality in veterans

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