title: Effect of statin use on outcomes of adults with candidemia.
abstract: BACKGROUND
  Statins have immunomodulatory properties and hinder Candida growth. However, it is unknown whether they may improve prognosis in patients with candidemia. We sought to determine the effect of prior statin use on the clinical outcomes of patients suffering candidemia.
  
  
  RESULTS
  Multicenter cohort study of hospitalized adults with candidemia between 2005 and 2011 in six hospitals in Spain, Brazil and Argentina. Of 326 candidemias, 44 (13.5%) occurred in statin users and 282 (86.5%) in statin non-users. The median value of APACHE II at candidemia diagnosis was similar between groups (18 vs. 16; p=.36). Candida albicans was the most commonly isolated species, followed by C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei. There were no differences regarding appropriate empirical antifungal treatment. Statin users had a lower early (5 d) case-fatality rate than non-users (4.5 vs. 17%; p=.031). This effect was not observed with other cardiovascular drugs (aspirin, beta blockers and ACE inhibitors). Independent factor related to early case-fatality rate was APACHE II score (AOR, 1.08; 95% CI, 1.03-1.14; p=.002). An appropriate empirical antifungal therapy (AOR, 0.11; 95% CI, 0.04-0.26; p=<.001) and prior statin use were independently associated with lower early case-fatality (AOR, 0.17; 95% CI, 0.03-0.93; p=.041). Fourteen days (14d) and overall (30d) case-fatality rates were similar between groups (27% vs. 29%; p=0.77 and 40% vs. 44%; p=.66).
  
  
  CONCLUSIONS
  The use of statins might have a beneficial effect on outcomes of patients with candidemia. This hypothesis deserves further evaluation in randomized trials.
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cuervo
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Francesc
authors.initials: F
authors.lastname: Puchades
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: Analía
authors.initials: A
authors.lastname: Mykietiuk
authors.forename: Adriana
authors.initials: A
authors.lastname: Manzur
authors.forename: Carlota
authors.initials: C
authors.lastname: Gudiol
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.forename: Diego
authors.initials: D
authors.lastname: Viasus
authors.forename: Josefina
authors.initials: J
authors.lastname: Ayats
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000328:Adult; D000368:Aged; D002175:Candida / Q000502:physiology; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors