title: Evidence To Support Continuation of Statin Therapy in Patients with Staphylococcus aureus Bacteremia.
abstract: In addition to cholesterol-lowering capabilities, statins possess anti-inflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes inStaphylococcus aureusbacteremia. We conducted a retrospective cohort study among hospitalized patients with positiveS. aureusblood 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 novousers 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= 331), pretreated with continuation (n= 141), andde novo(n= 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 inde 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 withS. aureusbacteremia, continuation of statin therapy among incident statin users was associated with significant beneficial effects on mortality, including a 54% lower 30-day mortality rate.
authors.affiliation: Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island, USA Aisling_Caffrey@uri.edu KerryLaPlante@uri.edu.|University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA.|Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Aisling R
authors.initials: AR
authors.lastname: Caffrey
authors.affiliation: Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island, USA.|University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA.
authors.forename: Tristan T
authors.initials: TT
authors.lastname: Timbrook
authors.affiliation: University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA.
authors.forename: Eunsun
authors.initials: E
authors.lastname: Noh
authors.affiliation: University of California San Diego School of Medicine, La Jolla, California, USA.
authors.forename: George
authors.initials: G
authors.lastname: Sakoulas
authors.affiliation: Infectious Disease Division, Memorial Hospital of Rhode Island, Providence, Rhode Island, USA.|Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Opal
authors.affiliation: University of California San Diego School of Medicine, La Jolla, California, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Nizet
authors.affiliation: Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, Rhode Island, USA Aisling_Caffrey@uri.edu KerryLaPlante@uri.edu.|University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA.|Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island, USA.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: LaPlante
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D004338:Drug Combinations; D004357:Drug Synergism; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: HMG-CoA reductase inhibitors; Staphylococcus aureus; anti-inflammatory and immunomodulatory effects; bacteremia; mortality; statins