title: Effect of statin therapy in the outcome of bloodstream infections due to Staphylococcus aureus: a prospective cohort study.
abstract: BACKGROUND
  Statins have pleiotropic effects that could influence the prevention and outcome of some infectious diseases. There is no information about their specific effect on Staphylococcus aureus bacteremia (SAB).
  
  
  METHODS
  A prospective cohort study including all SAB diagnosed in patients aged ≥18 years admitted to a 950-bed tertiary hospital from March 2008 to January 2011 was performed. The main outcome variable was 14-day mortality, and the secondary outcome variables were 30-day mortality, persistent bacteremia (PB) and presence of severe sepsis or septic shock at diagnosis of SAB. The effect of statin therapy at the onset of SAB was studied by multivariate logistic regression and Cox regression analysis, including a propensity score for statin therapy.
  
  
  RESULTS
  We included 160 episodes. Thirty-three patients (21.3%) were receiving statins at the onset of SAB. 14-day mortality was 21.3%. After adjustment for age, Charlson index, Pitt score, adequate management, and high risk source, statin therapy had a protective effect on 14-day mortality (adjusted OR = 0.08; 95% CI: 0.01-0.66; p = 0.02), and PB (OR = 0.89; 95% CI: 0.27-1.00; p = 0.05) although the effect was not significant on 30-day mortality (OR = 0.35; 95% CI: 0.10-1.23; p = 0.10) or presentation with severe sepsis or septic shock (adjusted OR = 0.89; CI 95%: 0.27-2.94; p = 0.8). An effect on 30-day mortality could neither be demonstrated on Cox analysis (adjusted HR = 0.5; 95% CI: 0.19-1.29; p = 0.15).
  
  
  CONCLUSIONS
  Statin treatment in patients with SAB was associated with lower early mortality and PB. Randomized studies are necessary to identify the role of statins in the treatment of patients with SAB.
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Luis E
authors.initials: LE
authors.lastname: López-Cortés
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Del Toro
authors.affiliation: Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Microbiología, Universidad de Sevilla, Seville, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Velasco
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: de Cueto
authors.affiliation: Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Caballero
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muniain
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Microbiología, Universidad de Sevilla, Seville, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000502:physiology; D016019:Survival Analysis; D063128:Tertiary Health Care; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors