Statin Medication Use and Nosocomial Infection Risk in the Acute Phase of Stroke.
OBJECTIVE
Statins have immunomodulatory and peripheral anti-inflammatory properties that are independent of their lipid-lowering action. Whether these properties reduce the risk for developing poststroke infection is debated in clinical literature. We estimated the risk for developing nosocomial poststroke infection based on statin exposure in patients aged 18 or older hospitalized for ischemic stroke.


METHODS
A consecutive sample of acute care hospital electronic medical records was retrospectively analyzed. Patients were assigned to the exposed cohort either when statin use preceded infection or statin medication was used, but no infection developed. The unexposed cohort included patients not on statins or initiating statins after infection developed. The association of statin exposure with infection was examined with conditional logistic regression adjusted for poststroke infection risk factors. Cochran-Mantel-Haenszel analyses examined the association of statin exposure and infection status within strata of binary predictor variables that increased infection risk.


RESULTS
Up to 1612 records were analyzed: 1151 in the exposed cohort and 461 in the unexposed cohort. Infection developed in 20% of the statin-exposed patients and in 41% of the statin-unexposed patients (P < .001). Exposure to statins reduced odds for developing nosocomial infection by 58% over no exposure (adjusted odds ratio = .418, P < .001). Statins lowered the infection risk for both sexes, patients with a nasogastric tube, and patients with dysphagia (P < .05). Statins did not change infection risk for patients with endotracheal intubation.


CONCLUSIONS
In patients with ischemic stroke and without endotracheal intubation, statin medications were associated with reduced risk of nosocomial infections.
St. Luke's Rehabilitation Institute, Spokane, Washington; Department of Biomedical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington. Electronic address: WeeksDL@st-lukes.org.
Douglas L
DL
Weeks
St. Luke's Rehabilitation Institute, Spokane, Washington; Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington.
Christopher L
CL
Greer
Providence Sacred Heart Medical Center, Spokane, Washington; Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington.
Megan N
MN
Willson
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Infection; ischemic stroke; risk factors; statin